ArticleJMIRx med
Utility of the ROX Index in Predicting Intubation for Patients With COVID-19-Related Hypoxemic Respiratory Failure Receiving High-Flow Nasal Therapy: Retrospective Cohort Study.
Article in JMIRx med. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prognostic models in COVID-19 infection that predict severity: a systematic review.European journal of epidemiology · 2023Pooled it
- The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7).Addiction (Abingdon, England) · 2021Pooled it
- Article
- Factors associated with the occurrence of COVID-19 in the pediatric population in hospital settings: a case-control study.Revista da Escola de Enfermagem da U S P · 2025Article
- Predictors of high-flow nasal cannula failure in COVID-19 patients in a northern Peruvian hospital.BMC pulmonary medicine · 2024Article
- Using the ROX Index to Predict Treatment Outcome for High-Flow Nasal Cannula and/or Noninvasive Ventilation in Patients With COPD Exacerbations.Respiratory care · 2024Article
- Article
- Article
- The role of ROX index-based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis.Acute and critical care · 2023Article
- Ratio of Oxygen Saturation to Inspired Oxygen, ROX Index, Modified ROX Index to Predict High Flow Cannula Success in COVID-19 Patients: Multicenter Validation Study.The western journal of emergency medicine · 2023Article
- Derivation and Validation of a Predictive Score for Respiratory Failure Worsening Leading to Secondary Intubation in COVID-19: The CERES Score.Journal of clinical medicine · 2022Article
- The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019.Balkan medical journal · 2022Article
- The timing of intubation and principles of ICU care in COVID-19Turkish journal of medical sciences · 2021Article
- Predictors of intubation in COVID-19 patients undergoing awake proning in the emergency department.The American journal of emergency medicine · 2021Article
- Protocol for assessing and predicting acute respiratory decline in hospitalized patients.STAR protocols · 2021Article
- Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article.Anesthesiology and pain medicine · 2021Review
- The COVID-19 Treatment Landscape: A South African Perspective on a Race Against Time.Frontiers in medicine · 2021Review
- Inflammatory Biomarker Trends Predict Respiratory Decline in COVID-19 Patients.Cell reports. Medicine · 2020Article
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe use of high-flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concerns about increased health care worker transmission and delays in invasive mechanical ventilation (IMV). Herein, we analyzed the utility of the noninvasive ROX (ratio of oxygen saturation) index to predict the need for and timing of IMV.
objectiveThis study aimed to assess whether the ROX index can be a useful score to predict intubation and IMV in patients receiving HFNT as treatment for COVID-19-related hypoxemic respiratory failure.
methodsThis is a retrospective cohort analysis of 129 consecutive patients with COVID-19 admitted to Temple University Hospital in Philadelphia, PA, from March 10, 2020, to May 17, 2020. This is a single-center study conducted in designated COVID-19 units (intensive care unit and other wards) at Temple University Hospital. Patients with moderate and severe hypoxemic respiratory failure treated with HFNT were included in the study. HFNT patients were divided into two groups: HFNT only and intubation (ie, patients who progressed from HFNT to IMV). The primary outcome was the value of the ROX index in predicting the need for IMV. Secondary outcomes were mortality, rate of intubation, length of stay, and rate of nosocomial infections in a cohort treated initially with HFNT.
resultsOf the 837 patients with COVID-19, 129 met the inclusion criteria. The mean age was 60.8 (SD 13.6) years, mean BMI was 32.6 (SD 8) kg/m², 58 (45%) were female, 72 (55.8%) were African American, 40 (31%) were Hispanic, and 48 (37.2%) were nonsmokers. The mean time to intubation was 2.5 (SD 3.3) days. An ROX index value of less than 5 at HFNT initiation was suggestive of progression to IMV (odds ratio [OR] 2.137,
conclusionsThe ROX index helps decide which patients need IMV and may limit eventual morbidity and mortality associated with the progression to IMV.
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