Rouba Chahine, PhD
Biostatistician
University of Alabama at Birmingham, United States
Disclosure information not submitted.
Inmaculada Aban, PhD
Professor of biostatistics
University of Alabama at Birmingham, United States
Disclosure information not submitted.
Priya Prabhakaran, MD
Pediatric Critical Care Faculty
University of Alabama at Birmingham, United States
Disclosure information not submitted.
Jeremy Loberger, MD
Pediatric Critical Care Faculty
Univ of Alabama at Birmingham, United States
Disclosure information not submitted.
Title: Predicting high flow nasal cannula therapy outcomes using the ROX-HR index in the pediatric ICU
Objective: High flow nasal cannula (HFNC) use is increasing in pediatric patients. Objective measures that predict HFNC outcomes are lacking. The Respiratory rate OXygenation (ROX) and Respiratory rate OXygenation-Heart Rate (ROX-HR) indices are validated to predict HFNC therapy failure in adults. This study examined the performance of both indices in predicting HFNC therapy failure in children admitted to the pediatric intensive care unit (PICU).
Methods: This retrospective, longitudinal, observational cohort study was completed in a 24-bed pediatric intensive care unit in a quaternary-care children’s hospital. All patients ≤ 24 months of age initiated on HFNC in the PICU from January 1, 2018 through August 31, 2020 were included. The ROX and ROX-HR index were collected at standardized time points during HFNC therapy. Performance in predicting HFNC failure was evaluated using area under the receiving operating characteristic curve (AUROC) and Kaplan-Meier survival analysis. Failure was defined as escalation of respiratory support to either noninvasive positive pressure ventilation or endotracheal intubation.
Results: Among 466 patient encounters, 111 (24.9%) failed HFNC therapy. HFNC failure was associated with lower ROX and ROX-HR indices at termination compared HFNC liberation (p<0.001). A ROX-HR index < 3 was significantly associated with a higher risk of HFNC failure at 1 (AUROC 0.76, p=0.015) and 6 (AUROC 0.81, p=0.016) hours.
Conclusion: ROX-HR may be a useful tool for early identification of patients ≤ 24 months at risk for HFNC failure and allow for earlier intervention. Larger prospective studies are necessary to validate the role of the ROX-HR index in pediatric patients.