Abstract
High-flow nasal cannula (HFNC) therapy is commonly used to prevent reintubation after planned extubation. In clinical practice, there are no appropriate tools to evaluate whether HFNC therapy was successful or failed after planned extubation. In this retrospective observational study, we investigated whether the use of the ROX index was appropriate to differentiate between HFNC success and failure within 72 h after extubation and to develop an integrated model including the ROX index to improve the prediction of HFNC success in patients receiving HFNC therapy after planned extubation. Of 276 patients, 50 patients (18.1%) were reintubated within 72 h of extubation. ROX index values of >8.7 at 2 h, >8.7 at 6 h, and >10.4 at 12 h after HFNC therapy were all meaningful predictors of HFNC success in extubated patients. In addition, the integrated model including the ROX index had a better predictive capability for HFNC success than the ROX index alone. In conclusion, the ROX index at 2, 6, and 12 h could be applied to extubated patients to predict HFNC success after planned extubation. To improve its predictive power, we should also consider an integrated model consisting of the ROX index, sex, body mass index, and the total duration of ventilator care.
Highlights
The use of a high-flow nasal cannula (HFNC) is useful for oxygen delivery in critically ill patients
Reintubation could be delayed in patients with HFNC application, and it could be associated with increased mortality [13,14,15]
This study investigated whether the use of the ROX index was appropriate to differentiate between HFNC success and failure within 72 h after extubation, and it aimed to develop an integrated model including the ROX index to improve the prediction of HFNC success in patients receiving HFNC after planned extubation
Summary
The use of a high-flow nasal cannula (HFNC) is useful for oxygen delivery in critically ill patients. The ROX index (Spo2 /Fio2 /respiratory rate) has recently been developed and validated to predict whether HFNC therapy will be successful within 24 h of commencement in patients with pneumonia-related ARF [16,17]. As the ROX index has been validated only in patients with pneumonia-related ARF, it cannot be applied to other clinical settings. As the ROX index is an effective bedside tool for predicting HFNC success, it should be validated for use in various clinical settings. This study investigated whether the use of the ROX index was appropriate to differentiate between HFNC success and failure within 72 h after extubation, and it aimed to develop an integrated model including the ROX index to improve the prediction of HFNC success in patients receiving HFNC after planned extubation
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