Evidence map›Paper›PMID 41884367›Full record

ArticleCHEST critical care2026

The Use of the Rox Index to Guide High-Flow Nasal Cannula Therapy and the Need for Intubation Is Associated With Meaningful Patient Outcomes.

Jonathan Taylor, Aaron Gans, Taylor Treacy, Ashish Bosukonda, Zhan Zhao, Neha N Goel

Abstract read
PubMed Full text at PMC Publisher
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Article in CHEST critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Jonathan TaylorInterdepartmental Division of Critical Care Medicine (J. S. T.), University of Toronto, Toronto, ON, Canada; the Division of Pulmonary, Critical Care, and Sleep Medicine (A. G, T. T, and N. N. G.), the Department of Medicine (A. G, T. T, and N. N. G.), the Department of Population Health Science and Policy (Z. Z.), Mount Sinai Hospital, New York, NY; and the Department of Critical Care (A. B.), Baystate Medical Center, Springfield, MA.
Aaron GansInterdepartmental Division of Critical Care Medicine (J. S. T.), University of Toronto, Toronto, ON, Canada; the Division of Pulmonary, Critical Care, and Sleep Medicine (A. G, T. T, and N. N. G.), the Department of Medicine (A. G, T. T, and N. N. G.), the Department of Population Health Science and Policy (Z. Z.), Mount Sinai Hospital, New York, NY; and the Department of Critical Care (A. B.), Baystate Medical Center, Springfield, MA.
Taylor TreacyInterdepartmental Division of Critical Care Medicine (J. S. T.), University of Toronto, Toronto, ON, Canada; the Division of Pulmonary, Critical Care, and Sleep Medicine (A. G, T. T, and N. N. G.), the Department of Medicine (A. G, T. T, and N. N. G.), the Department of Population Health Science and Policy (Z. Z.), Mount Sinai Hospital, New York, NY; and the Department of Critical Care (A. B.), Baystate Medical Center, Springfield, MA.
Ashish BosukondaInterdepartmental Division of Critical Care Medicine (J. S. T.), University of Toronto, Toronto, ON, Canada; the Division of Pulmonary, Critical Care, and Sleep Medicine (A. G, T. T, and N. N. G.), the Department of Medicine (A. G, T. T, and N. N. G.), the Department of Population Health Science and Policy (Z. Z.), Mount Sinai Hospital, New York, NY; and the Department of Critical Care (A. B.), Baystate Medical Center, Springfield, MA.
Zhan ZhaoInterdepartmental Division of Critical Care Medicine (J. S. T.), University of Toronto, Toronto, ON, Canada; the Division of Pulmonary, Critical Care, and Sleep Medicine (A. G, T. T, and N. N. G.), the Department of Medicine (A. G, T. T, and N. N. G.), the Department of Population Health Science and Policy (Z. Z.), Mount Sinai Hospital, New York, NY; and the Department of Critical Care (A. B.), Baystate Medical Center, Springfield, MA.
Neha N GoelInterdepartmental Division of Critical Care Medicine (J. S. T.), University of Toronto, Toronto, ON, Canada; the Division of Pulmonary, Critical Care, and Sleep Medicine (A. G, T. T, and N. N. G.), the Department of Medicine (A. G, T. T, and N. N. G.), the Department of Population Health Science and Policy (Z. Z.), Mount Sinai Hospital, New York, NY; and the Department of Critical Care (A. B.), Baystate Medical Center, Springfield, MA.

Funding

Optimizing the use of noninvasive respiratory support in the Emergency DepartmentK23HL161316 · NHLBI · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI Neha Neelam Goel · 2023 to 2026
$757k
NHLBI NIH HHS K23 HL161316
6 · The paper itself

Abstract

backgroundAcute hypoxemic respiratory failure (AHRF) is a common and life-threatening condition frequently managed with high-flow nasal cannula (HFNC) oxygenation. The ROX index, the ratio of oxygen saturation to FIO RESEARCH QUESTION: What is the impact on outcomes when the ROX index is used to guide decisions-making in the timing of intubation in patients receiving high-flow nasal cannula therapy? STUDY DESIGN AND

methodsA retrospective observational cohort study at an academic medical center emergency department (ED) was undertaken. Two hundred thirty-three adults were initiated on HFNC oxygenation for AHRF between January and December 2022. ROX indices were calculated retrospectively at 4, 6, and 12 hours after HFNC oxygenation initiation. Patients were categorized based on whether their care aligned with ROX predictions as ROX concordant or ROX discordant. The primary outcome was persistent organ dysfunction plus death (POD+D), a composite measure of death and ongoing need for mechanical ventilation, vasopressors, or new dialysis, assessed at day 28.

resultsEighty-two percent of patients (n = 191) received ROX-concordant care, whereas 18% of patients (n = 42) received ROX-discordant care. Despite similar baseline characteristics, patients receiving ROX-discordant care experienced significantly worse outcomes: higher POD+D (62% vs 16%;

interpretationIn patients treated with HFNC oxygenation in the ED, clinical decisions aligned with ROX index predictions were associated with significantly better outcomes. Discordant care, especially premature intubation, correlates with increased morbidity and mortality. These findings support prospective validation of improved outcomes with ROX-concordant actions.

Indexed as

high-flow nasal cannulahypoxemic respiratory failureintubationROX index

Identifiers

PMID41884367
PMCPMC13012275

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

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.