key: cord-0820528-lssuwk1n
authors: Yousuf, Asfandyar; Gottlieb, David Shimon; Aggarwal, Aneesh; Peacock, Bernadette; Konda, Shruthi
title: An observational longitudinal study of the use of ROX index to predict treatment failure in patients receiving continuous positive airway pressure for COVID‐19
date: 2022-01-12
journal: Health Sci Rep
DOI: 10.1002/hsr2.482
sha: b299621180e94cab6393f5a6aabb89ef86ea540b
doc_id: 820528
cord_uid: lssuwk1n

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Five percent of patients with COVID-19 develop the critical disease, with one of the complications being acute hypoxemic respiratory failure (AHRF) requiring advanced respiratory support. 1 In April 2020, the British Thoracic Society (BTS) issued guidance for the delivery of continuous positive airway pressure (CPAP) to patients with AHRF as a bridging therapy prior to escalation to the intensive care unit (ICU). 2 This therapy has been shown to benefit patients with AHRF due to COVID-19 in a large multi-center trial RECOVERY-RS, their findings are still awaiting peer review. 3 Evidence is needed on how to safely manage these patients outside of ICU and prevent unnecessary delay of intubation. 4 The use of ROX index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) was validated in 2019 to predict whether patients with AHRF can be safely managed on HFNO or if invasive mechanical ventilation (IMV) should be considered. 5 ROX index has also been studied in patients with COVID-19 on HFNO and higher values were found to be associated with HFNO success. 6, 7 This study investigated whether there is an association between ROX index before starting CPAP and within the first 24 hours of starting it and our outcome measure -whether patients were weaned off or failed CPAP. Failure was defined as either death or needing IMV depending on their treatment escalation plan. Figure 1A ).

ROX index was significantly greater in the group that was weaned compared to the group that failed CPAP ( Figure 1B) . ROX index on admission did not meet the test of significance for those who were weaned vs those who failed CPAP. These studies looked at patients who were already in ICU and were receiving HFNO for respiratory support. However, we looked at the utility of the ROX index as a prognostic indicator in patients receiving CPAP on a respiratory ward. Our results show that ROX index before starting CPAP and within 24 hours of initiation can differentiate patients with COVID-19 related AHRF who are likely to wean or fail CPAP. Increasing significance of ROX index' association

Clinical management of COVID 19. Interim guidance

Respiratory Support of Patients on Medical Wards

An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19

COVID-19: respiratory support outside the intensive care unit

An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: a multi-Centre prospective observational study

Prediction of outcome of nasal high fow use during COVID-19-related acute hypoxemic respiratory failure

An observational longitudinal study of the use of ROX

https://orcid.org/0000-0002-8570-0211David Shimon Gottlieb https://orcid.org/0000-0002-5897-8410