The clinical value of the modified respiratory rate-oxygenation index incorporating heart rate in the early prediction of patients undergoing high flow nasal cannula therapy
10.3969/j.issn.1008-9691.2025.02.007
- VernacularTitle:结合心率的改良呼吸频率氧合指数在经鼻高流量氧疗患者早期预测中的临床价值
- Author:
Yue MAO
1
;
Shuying YANG
1
Author Information
1. 天津市第一中心医院重症医学科,天津 300192
- Publication Type:Journal Article
- Keywords:
Modified respiratory rate-oxygenation index incorporating heart rate;
Respiratory rate-oxygenation index;
Heart rate;
High flow nasal cannula;
Prediction
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2025;32(2):160-165
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical significance of the modified respiratory rate-oxygenation(ROX)index incorporating heart rate(HR)in patients undergoing high flow nasal cannula(HFNC)therapy,and to compare the value of ROX-HR and ROX indices in early prediction of HFNC outcomes.Methods Patients who received continuous HFNC therapy in department of intensive care unit of Tianjin First Central Hospital from January 2022 to June 2023 were selected as study subjects.A total of 153 patients were included in the analysis.Of these,103 patients(67.3%)received HFNC due to acute respiratory failure,while 50 patients(32.7%)started HFNC after extubation.Patients were divided into HFNC success and HFNC failure groups based on the success of HFNC therapy.HR and ROX indices were recorded before HFNC initiation and at 1,2,4,6,8,10,12,18,24,and 48 hours after HFNC initiation,and the ROX-HR index was calculated.Plot the receiver operator characteristic curve(ROC curve),and calculate area under the curve(AUC)to evaluate the predictive value of ROX-HR and ROX index for success and failure of HFNC in patients with acute respiratory failure receiving HFNC treatment after extubation.Results Among patients with acute respiratory failure undergoing HFNC,HFNC failure was associated with higher acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)scores[APACHEⅡscore:19.86(14.26,27.41)vs.16.24(13.60,22.69),SOFA score:5(4,6)vs.4(3,5),both P<0.05].Among patients who started HFNC after extubation,immunocompromised status was a significant factor associated with HFNC failure,with a higher proportion of immunocompromised patients in the HFNC failure group compared to the HFNC success group[77.8%(14/18)vs.31.3%(10/32),P<0.05].For patients with acute respiratory failure starting HFNC,the ROX-HR index could effectively distinguish HFNC success from failure at all time points(AUC>0.650).For patients who started HFNC after extubation,the ROX-HR index remained lower in the HFNC failure group.However,unlike the ROX-HR index,the ROX index seemed unable to effectively differentiate HFNC success from failure,with no significant statistical differences between the HFNC success and failure groups at 2,4,8,18,and 48 hours after extubation.In patients who started HFNC after extubation,HR alone could predict HFNC outcomes,with AUC and 95%confidence intervals(95%CI)of 0.695(0.530-0.860)and 0.698(0.527-0.868)at 2 hours and 4 hours,respectively,and P values of 0.041 and 0.038,respectively.Conclusion The ROX-HR index is a promising tool for early identification of patients at high risk of HFNC failure.
