SynthesisJournal of critical care2021
ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis.
Synthesis in Journal of critical care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
83 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Pooled it
- Noninvasive oxygenation and ventilation strategies for viral acute respiratory failure: a comprehensive systematic review and meta-analysis.Systematic reviews · 2025Pooled it
- Performance of the ROX index in predicting high flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis.Critical care (London, England) · 2023Pooled it
- High flow nasal oxygen and awake prone positioning - Two allies against COVID-19: A systematic review.Respiratory physiology & neurobiology · 2023Pooled it
- The ROX index as a predictor of high-flow nasal cannula outcome in pneumonia patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis.BMC pulmonary medicine · 2022Pooled it
- Predicting Failure at Initiation of High-Flow Nasal Oxygen in Patients With COVID-19: Literature Review, Development and Internal Validation of a Prediction Model.Respirology (Carlton, Vic.) · 2026Observational
- Article
- Review
- Beyond High-flow Nasal Cannula vs Non-invasive Ventilation: The Need for Dynamic Physiological Monitoring in Pediatric Acute Hypoxemic Respiratory Failure.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Predicting high-flow nasal cannula failure: beyond static indices toward dynamic physiologic assessment.Journal of intensive care · 2026Article
- Prognostic significance of the ROX index in patients with acute exacerbation of interstitial lung disease treated with high-flow nasal cannula oxygen therapy: a retrospective cohort study.BMC pulmonary medicine · 2026Article
- Prediction of high-flow nasal cannula failure in critically ill patients: a narrative review.Journal of intensive care · 2026Review
- The Use of the Rox Index to Guide High-Flow Nasal Cannula Therapy and the Need for Intubation Is Associated With Meaningful Patient Outcomes.CHEST critical care · 2026Article
- Advances in mechanical ventilation for critically ill patients: strategies for respiratory support and complication management.American journal of translational research · 2026Review
- Predicting failure of extubation and non-invasive respiratory support in critically ill patients: clinical complexity, limitations of traditional indices, and machine learning perspectives.Frontiers in medicine · 2026Review
- Early Prediction of High-flow Nasal Cannula Failure in Children: Clarifying the Evidence Behind the Pediatric HACOR Score.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026Article
- Development and external validation of a machine learning model to predict high flow nasal cannula failure.BMJ open respiratory research · 2025Article
- Acute Care of Patients with Moderate Respiratory Distress: Recommendations from an American College of Emergency Physicians Expert Panel.The western journal of emergency medicine · 2025Article
- Evaluation of physiological severity scores for predicting COVID-19 disease progression: a retrospective study.BMC infectious diseases · 2025Article
- High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study.Respiratory research · 2025Observational
23 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePrediction of high flow nasal cannula (HFNC) failure in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) may improve clinical management and stratification of patients for optimal treatment. We performed a systematic review and meta-analysis to determine performance of ROX index as a predictor of HFNC failure. MATERIALS AND
methodsSystematic search was performed in electronic databases (PubMed, Google Scholar, Web of Science and Cochrane Library) for articles published till 15 June 2021 investigating ROX index as a predictor for HFNC failure. Quality In Prognosis Studies (QUIPS) tool was used to analyze risk of bias for prognostic factors, by two independent authors.
resultsEight retrospective or prospective cohort studies involving 1301 patients showed a good discriminatory value, summary area under the curve (sAUC) 0.81 (95% CI, 0.77-0.84) with sensitivity of 0.70 (95% CI, 0.59-0.80) and specificity of 0.79 (95% CI, 0.67-0.88) for predicting HNFC failure. The positive and negative likelihood ratio were 3.0 (95% CI, 2.2-5.3) and 0.37 (95% CI, 0.28-0.50) respectively, and was strongly associated with a promising predictive accuracy (Diagnostic odds ratio (DOR) 9, 95% CI, 5-16).
conclusionThis meta-analysis suggests ROX index has good discriminating power for prediction of HFNC failure in COVID-19 patients with AHRF.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.