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Association between respiratory rate oxygenation index and need for positive pressure ventilation in children on high
Nirupama Kannikeswaran1, Peter Whittaker2, Usha Sethuraman3
1Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, 3901 Beaubien Blvd, Detroit, MI, 48201, USA. nkannike@dmc.org.
Insights
The Respiratory Rate Oxygenation (ROX) index can help predict the need for positive pressure ventilation (PPV) in young children with bronchiolitis receiving high flow nasal cannula (HFNC) therapy. A lower ROX score indicates a higher likelihood of requiring PPV.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Critical Care
Background:
- High flow nasal cannula (HFNC) therapy is frequently used for bronchiolitis in young children.
- Predictors for the need for positive pressure ventilation (PPV) in this population are crucial for timely intervention.
- Previous studies have explored demographic and clinical factors associated with HFNC use in pediatric bronchiolitis.
Purpose of the Study:
- To investigate the association between the Respiratory Rate Oxygenation (ROX) index and the requirement for PPV in children under two years old diagnosed with bronchiolitis.
- To evaluate the predictive value of the ROX index for PPV need in pediatric patients on HFNC therapy.
Main Methods:
- A single-center prospective observational study was conducted.
- 373 children under two years of age with bronchiolitis receiving HFNC were included.
- The ROX index (pulse oximetry/FiO2/respiratory rate) was calculated at HFNC initiation. Logistic regression was used to analyze the association with PPV need.
Main Results:
- 13.1% (49 out of 373) of patients required PPV.
- Patients needing PPV had a significantly lower ROX index compared to those who did not (5.86 vs. 6.74, p=0.01).
- Children in the lowest ROX quartile (<5.39) were three times more likely to require PPV than those in the highest quartile (>8.21), even after adjusting for confounders (OR 3.1, p=0.02).
Conclusions:
- A low ROX index is significantly associated with an increased likelihood of requiring PPV in young children with bronchiolitis treated with HFNC.
- The ROX index demonstrates acceptable discrimination in identifying children at higher risk for PPV.
- Further validation in larger and diverse populations is recommended to confirm the ROX threshold for risk stratification.
Abstract:
Our objective was to evaluate the association of respiratory rate oxygenation index (ROX) with the need for positive pressure ventilation in children < 2 years of age with bronchiolitis on high flow nasal cannula (HFNC) therapy. We performed a single-center prospective observational study of a convenience sample of children < 2 years of age with bronchiolitis who had HFNC initiated in the pediatric emergency department between November and March, 2018-2020. ROX was calculated as pulse oximetry/FiO2/respiratory rate at HFNC initiation. Demographics, need for positive pressure ventilation (PPV), disposition, and hospital length of stay were collected. Logistic regression model was used to determine the odds ratio for PPV need relative to the highest ROX quartile. Of the 373 patients included, 49 (13.1%) required PPV. ROX was lower in patients who required PPV compared with those who did not (5.86 [4.71-7.42] vs. 6.74 [5.46-8.25]; p = 0.01). Logistic regression revealed that those patients whose ROX was in the lowest quartile (< 5.39) were three times more likely to require PPV compared to those in the highest quartile (> 8.21). These results held true after adjusting for confounders (odds ratio 3.1; 95% CI [1.3 to 7.5]; p = 0.02). The model's AUROC (0.701) indicated acceptable discrimination between cases and controls.
Conclusion:
Low ROX index was associated with the need for PPV in children with bronchiolitis on HFNC. The risk stratification provided and ROX threshold for risk stratification require confirmation in other populations with a larger sample size.
What Is Known:
• Demographic and clinical factors associated with high flow nasal cannula (HFNC) therapy in children with bronchiolitis has been studied.
What Is New:
• This is the first study to report the utility of association of Respiratory Rate Oxygenation (ROX) index for need for positive pressure ventilation (PPV) in children < 2 years of age with bronchiolitis on HFNC therapy. • ROX was lower in children who required PPV and children whose ROX was in the lowest quartile (< 5.39) were three times more likely to require PPV compared to those in the highest quartile (> 8.21).
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