Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure

被引：26

作者：

Lemiale, Virginie ^{[1
,2
]}

Dumas, Guillaume ^{[1
,2
]}

Demoule, Alexandre ^{[3
,4
]}

Pene, Frederic ^{[5
]}

Kouatchet, Achille ^{[6
]}

Bisbal, Magali ^{[7
]}

Nseir, Saad ^{[8
]}

Argaud, Laurent ^{[9
]}

Kontar, Loay ^{[10
]}

Klouche, Kada ^{[11
]}

Barbier, Francois ^{[12
]}

Seguin, Amelie ^{[13
]}

Louis, Guillaume ^{[14
]}

Constantin, Jean-Michel ^{[15
]}

Mayaux, Julien ^{[3
,4
]}

Wallet, Florent ^{[16
]}

Peigne, Vincent ^{[17
]}

Girault, Christophe ^{[18
]}

Oziel, Johanna ^{[19
]}

Nyunga, Martine ^{[20
]}

Terzi, Nicolas ^{[21
]}

Bouadma, Lila ^{[22
]}

Lautrette, Alexandre ^{[23
]}

Bige, Naike ^{[24
]}

Raphalen, Jean-Herle ^{[25
]}

Papazian, Laurent ^{[26
]}

Bruneel, Fabrice ^{[27
]}

Lebert, Christine ^{[28
]}

Benoit, Dominique ^{[29
]}

Meert, Anne-Pascale ^{[30
]}

Jaber, Samir ^{[31
]}

Mokart, Djamel ^{[7
]}

Darmon, Michael ^{[1
,2
]}

Azoulay, Elie ^{[1
,2
]}

机构：

[1] Hop St Louis, AP HP, Med Intens Care Unit, 1 Ave Claude Vellefaux, F-75010 Paris, France

[2] Hop St Louis, AP HP, Dept Biostat, 1 Ave Claude Vellefaux, F-75010 Paris, France

[3] Sorbonne Univ, Med Intens Care Unit, Paris, France

[4] Sorbonne Univ, Hop Pitie Salpetriere, Div Resp, Paris, France

[5] Univ Paris 05, Hosp Cochin, AP HP, Med Intens Care Unit, Paris, France

[6] CHRU, Med Intens Care Unit, Angers, France

[7] Paoli Calmettes Inst, Intens Care Unit, Marseille, France

[8] CHU Lille, Crit Care Ctr, Lille, France

[9] Hop Edouard Herriot, Hosp Civils Lyon, Med Intens Care Unit, Lyon, France

[10] Amiens Univ Hosp, INSERM U1088, Med Intens Care Unit, Amiens, France

[11] CHU Montpellier, Med Intens Care Unit, Montpellier, France

[12] CHR Orleans, La Source Hosp, Med Intens Care Unit, Orleans, France

[13] CHU Nantes, Hotel Dieu, Med Intens Care Unit, Nantes, France

[14] CHR Metz Thionville, Intens Care Unit, Metz, France

[15] CHU Clermont Ferrand, Dept Perioperat Med, Clermont Ferrand, France

[16] Lyon Sud Med Ctr, Intens Care Unit, Lyon, France

[17] Ctr Hosp Metropole Savoie, Intens Care Unit, Chambery, France

[18] Hop Charles Nicolle, Med Intens Care Unit, Rouen, France

[19] Avicenne Univ Hosp, Med Intens Care Unit, Bobigny, France

[20] Roubaix Hosp, Intens Care Unit, Roubaix, France

[21] CHU Grenoble Alpes, Med Intens Care Unit, Grenoble, France

[22] CHU Bichat, Med Intens Care Unit, Paris, France

[23] Gabriel Montpied Univ Hosp, Med Intens Care Unit, Clermont Ferrand, France

[24] CHU St Antoine, Med Intens Care Unit, Paris, France

[25] Hop Necker Enfants Malad, Dept Anesthesia & Crit Care, Paris, France

[26] Aix Marseille Univ, Hop Nord, AP HM, Reanimat Detresses Resp & Infect Severes,Fac Med, Marseille, France

[27] Andre Mignot Hosp, Med Intens Care Unit, Versailles, France

[28] Ctr Hosp Dept Oudairies, Intens Care Unit, La Roche Sur Yon, France

[29] Ghent Univ Hosp, Dept Intens Care, Ghent, Belgium

[30] Univ Libre Bruxelles ULB, Inst Jules Bordet, Serv Med Interne Soins Intensifs & Urgences Oncol, Brussels, Belgium

[31] Montpellier Univ Hosp, PhyMedExp, INSERM U1046, CNRS, F-34295 Montpellier, France

来源：

ANNALS OF INTENSIVE CARE | 2021年 / 11卷 / 01期

关键词：

High-flow nasal oxygen; Immunocompromised; Acute respiratory failure; THERAPY; OXYGEN;

D O I：

10.1186/s13613-021-00801-z

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. Results In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1-3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69-7.01) vs. 6.10 (4.48-8.68), p < 0.001]. The accuracy of the ROX index to predict intubation was poor [AUC = 0.623 (0.557-0.689)], with low performance using the threshold previously found (4.88). In multivariate analysis, a higher ROX index was still independently associated with a lower intubation rate (OR = 0.89 [0.82-0.96], p = 0.04). Conclusion A ROX index greater than 4.88 appears to have a poor ability to predict intubation in immunocompromised patients with acute respiratory failure, although it remains highly associated with the risk of intubation and may be useful to stratify such risk in future studies.

引用

页数：9

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