ROX (Respiratory rate–OXygenation) index to predict early response to high‐flow nasal cannula therapy in infants with viral bronchiolitis

Introduction High‐flow nasal cannula (HFNC) is commonly used as first step respiratory support in infants with moderate‐to‐severe acute viral bronchiolitis (AVB). This device, however, fails to effectively manage respiratory distress in about a third of patients, and data are limited on determinants...

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Published in:Pediatric pulmonology 2024-04, Vol.59 (4), p.982-990
Main Authors: Milesi, Christophe, Nogue, Erika, Baleine, Julien, Moulis, Lionel, Pouyau, Robin, Gavotto, Arthur, Brossier, David, Mortamet, Guillaume, Cambonie, Gilles
Format: Article
Language:English
Subjects:
Adult
bronchiolitis
Bronchiolitis - therapy
Bronchiolitis, Viral - therapy
Cannula
Dyspnea - therapy
failure
high‐flow nasal cannula
Humans
Infant
Life Sciences
Oxygen Inhalation Therapy
Physiology
Pneumonia - therapy
Respiratory Distress Syndrome - therapy
Respiratory Insufficiency - therapy
Respiratory Rate
risk prediction
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Summary:Introduction High‐flow nasal cannula (HFNC) is commonly used as first step respiratory support in infants with moderate‐to‐severe acute viral bronchiolitis (AVB). This device, however, fails to effectively manage respiratory distress in about a third of patients, and data are limited on determinants of patient response. The respiratory rate–oxygenation (ROX) index is a relevant tool to predict the risk for HFNC failure in adult patients with lower respiratory tract infections. The primary objective of this study was to assess the relationship between ROX indexes collected before and 1 h after HFNC initiation, and HFNC failure occurring in the following 48 h in infants with AVB. Method This is an ancillary study to the multicenter randomized controlled trial TRAMONTANE 2, that included 286 infants of less than 6 months with moderate‐to‐severe AVB. Collection of physiological variables at baseline (H0), and 1 h after HFNC (H1), included heart rate (HR), respiratory rate (RR), fraction of inspired oxygen (FiO2), respiratory distress score (modified Wood's Clinical Asthma Score [mWCAS]), and pain and discomfort scale (EDIN). ROX and ROX‐HR were calculated as SpO 2 FiO 2 RR $\frac{\left(\frac{{\mathrm{SpO}}_{2}}{{\mathrm{FiO}}_{2}}\right)}{\mathrm{RR}}$ and 100 × ROX HR $100\times \frac{\mathrm{ROX}}{\mathrm{HR}}$, respectively. Predefined HFNC failure criteria included increase in respiratory distress score or RR, increase in discomfort, and severe apnea episodes. The accuracies of ROX, ROX‐HR indexes and clinical variable to predict HFNC failure were assessed using receiver operating curve analysis. We analyzed predictive factors of HFNC failure using multivariate logistic regressions. Result HFNC failure occurred in 111 of 286 (39%) infants, and for 56 (50% of the failure) of them within the first 6 h. The area under the curve of ROX indexes at H0 and H1 were, respectively, 0.56 (95% confidence interval [CI] 0.48–0.63, p = 0.14), 0.56 (95% CI 0.49–0.64, p = 0.09). ROX‐HR performances were better but remained poorly discriminant. HFNC failure was associated with higher mWCAS score at H1 (p 
ISSN:8755-6863
1099-0496
DOI:10.1002/ppul.26860