Predictive value of vox index for outcomes of non-invasive ventilation in elderly patients with moderate acute respiratory distress syndrome
10.3760/cma.j.cn431274-20240903-01360
- VernacularTitle:VOX指数对老年中度急性呼吸窘迫综合征患者无创通气结局的预测价值
- Author:
Wenlong NIE
1
;
Xuelian SUN
1
;
Zhen HAN
1
Author Information
1. 首都医科大学附属北京友谊医院急诊科，北京 100050
- Publication Type:Journal Article
- Keywords:
Acute respiratory distress syndrome;
Noninvasive ventilation;
VOX index;
Aged
- From:
Journal of Chinese Physician
2025;27(11):1672-1676
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the factors that can predict the outcome of non-invasive ventilation (NIV) in elderly patients with moderate acute respiratory distress syndrome (ARDS) and analyze their clinical application value.Methods:A total of 87 elderly patients with moderate ARDS caused by community-acquired pneumonia admitted to the Emergency Department of Beijing Friendship Hospital from January 2023 to December 2023 were retrospectively selected. Taking the need for conversion to invasive ventilation during treatment as the study endpoint, the patients were divided into NIV success group and failure group. Clinical data of patients were collected every 2 hours starting from 2 hours after the initiation of NIV, and differences between the two groups were compared. The predictive efficacy of potential risk factors was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).Results:Among the 87 patients, 38 cases failed NIV within 48 hours (overall failure rate 43.7%), including 18 cases failing within the first 12 hours and 20 new failures from 12 to 48 hours, while the remaining 49 cases succeeded. There were no statistically significant differences between the two groups in gender, age, prevalence of hypertension and diabetes, left ventricular ejection fraction, serum creatinine, total bilirubin, heart rate, N-terminal pro-brain natriuretic peptide (NT-proBNP), inspiratory positive airway pressure (IPAP), arterial blood pH, partial pressure of arterial carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), mean arterial pressure, Sequential Organ Failure Assessment (SOFA) score, respiratory rate and other indicators (all P>0.05). The failure group had a significantly lower baseline VOX index [(SpO 2/FiO 2)/VT] than the success group. From 2 to 12 hours after the initiation of NIV (a total of 6 recording time points), the VOX index in the failure group was significantly lower than that in the success group (all P<0.001). ROC curve analysis showed that the VOX index had the best predictive efficacy at 4-6 hours after NIV initiation: at 4 hours, the AUC was 0.929, and the optimal cut-off value of 24.72 had the highest sensitivity (91.84%) for predicting failure; at 6 hours, the AUC was 0.870, and the optimal cut-off value of 24.58 had the highest specificity (90.91%) for predicting failure. Conclusions:The VOX index can effectively predict the failure outcome of NIV in elderly patients with moderate ARDS, and its predictive ability is the strongest at 4-6 hours after the initiation of NIV. Clinically, the 4-hour or 6-hour time window can be selected to evaluate the prognosis according to the patient′s specific conditions (such as respiratory drive intensity, weaning risk), providing a reference for timely adjustment of respiratory support plans.
