Related Experiment Video
Updated: Sep 4, 2025
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Predicting High-Flow Nasal Cannula Therapy Outcomes Using the ROX-HR Index in the Pediatric ICU
Lece V Webb1, Rouba Chahine2, Inmaculada Aban2
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama. lvwebb@uabmc.edu.
Insights
The ROX-HR index may help identify children at risk of high-flow nasal cannula (HFNC) therapy failure early. This pediatric ICU study found lower ROX-HR scores predicted HFNC failure, suggesting its potential for timely intervention.
Area of Science:
- Pediatric critical care medicine
- Respiratory support
- Clinical outcome prediction
Background:
- High-flow nasal cannula (HFNC) use is rising in pediatric patients.
- Objective measures to predict HFNC outcomes are needed.
- Existing ROX and ROX-HR indices are validated in adults but not children.
Purpose of the Study:
- To evaluate the performance of ROX and ROX-HR indices in predicting HFNC therapy failure in pediatric ICU patients.
- To assess the utility of these indices for early identification of treatment failure.
Main Methods:
- Retrospective, longitudinal, observational cohort study in a pediatric ICU.
- Included patients ≤ 24 months old initiated on HFNC.
- Collected ROX and ROX-HR indices at standardized time points.
- Defined failure as escalation to noninvasive or invasive ventilation.
Main Results:
- 24.9% of 446 patients failed HFNC therapy.
- Lower ROX and ROX-HR indices at termination correlated with HFNC failure.
- A ROX-HR index < 3 predicted higher failure risk at 1 and 6 hours (AUROC 0.76-0.81).
Conclusions:
- The ROX-HR index shows promise for early identification of pediatric patients at risk of HFNC failure.
- Early identification may allow for timely intervention.
- Further prospective studies are needed to validate the ROX-HR index in pediatric populations.
Background:
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 ROX 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 ICU (PICU).
Methods:
This retrospective, longitudinal, observational cohort study was completed in a 24-bed PICU in a quaternary care children's hospital. All subjects ≤ 24 months of age initiated on HFNC in the PICU from January 1, 2018-August 31, 2020, were included. The ROX and ROX-HR indices were collected at standardized time points during HFNC therapy. Performance in predicting HFNC failure was evaluated using area under the receiver operating characteristic curve (AUROC) and Kaplan-Meier survival analysis. Failure was defined as escalation of respiratory support to either noninvasive ventilation or endotracheal intubation.
Results:
Among 446 subject encounters, 111 (24.9%) failed HFNC therapy. HFNC failure was associated with lower ROX and ROX-HR indices at termination compared to HFNC liberation (P < .001). A ROX-HR index < 3 was significantly associated with a higher risk of HFNC failure at 1 (AUROC 0.76, P = .01) and 6 (AUROC 0.81, P = .02) h.
Conclusions:
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 utility of the ROX-HR index in pediatric patients.
More Related Videos
14:28Non-Invasive Monitoring of Microvascular Oxygenation and Reactive Hyperemia using Hybrid, Near-Infrared Diffuse Optical Spectroscopy for Critical Care
Published on: May 10, 2024
07:51Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
Published on: May 21, 2019
Related Concept Videos
01:26Oxygen Delivering System I: Nasal Cannula and Face Mask
Nasal Cannula
A nasal cannula is a lightweight tube split at one end into two prongs and placed in the nostrils. It is typically used to deliver low to medium levels of oxygen.
Suggested flow rate: The suggested flow rate for a nasal cannula typically ranges between 1 and 6 L/min.
Oxygen percentage setting:...
01:29Administering Oxygen by Nasal Cannula
Nasal Cannulas
A nasal cannula is a lightweight tube split into two prongs placed in the nostrils,...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:23Acute Respiratory Failure-IV