Infants with bronchiolitis with high-flow nasal cannula in the paediatric ward. Is there a role for the ROXi (respiratory rate-oxygenation index) in predicting failure of high-flow nasal cannula?

The respiratory rate-oxygenation index (ROXi) has been shown to be a reliable tool for predicting the risk of high-flow nasal cannula (HFNC) failure in adult patients with lower respiratory tract infections. However, the usefulness of the ROXi in paediatrics remains to be shown. The objective of this study was to evaluate the ability of the ROXi collected at the initiation of HFNC in the paediatric ward to predict HFNC failure in cases of bronchiolitis. A multicentre retrospective cohort study was performed over the epidemic seasons (October to March) from 2018 to 2023 in seven paediatric and/or neonatal conventional or intermediate care units. Patients aged 0 to 6 months with bronchiolitis hospitalised in a participating unit who received HFNC were included. Demographic, clinical, and biochemical variables were collected at admission and HFNC initiation. Initial management and its evolution were described. Patients were compared on the basis of HFNC failure, defined as the need to escalate respiratory support, either invasive or non-invasive. Multivariable regression analysis was used to determine parameters associated with HFNC failure. We included 383 infants in this multicentric study (median age 63 days [7-192]). HFNC failure was observed in 73 patients (19%); among them, 61 (80%) were transferred to the PICU. In our population, the optimal ROXi for prediction of HNFC failure was 7.6 (sensitivity 62.5% and specificity 66.8%, area under the curve (AUC): 0.647). In the multivariate analysis, explanatory variables for HFNC failure were preterm birth, younger age (under 3 months old), modified-Wood's clinical asthma score (m-WCAS) ≥ 3, and hypotonia prior to HFNC initiation.

conclusionOur study failed to demonstrate the reliability of ROXi collected at the initiation of HFNC in the paediatric ward in the case of bronchiolitis. WHAT IS KNOWN: • Over the past decade, there has been a growing interest in the use of high flow nasal cannula (HFNC) for bronchiolitis hospitalised outside the paediatric intensive care unit (PICU). • Patients at risk of HFNC failure must be determined, and to this extent, the ability of the respiratory rate-oxygenation index (ROXi) should be further evaluated. WHAT IS NEW: • ROXi is not reliable in predicting HFNC failure in patients with bronchiolitis. • ROXi should be further prospectively evaluated, in a dynamic fashion, in association with clinical scales.