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Failure Prediction of High-Flow Nasal Cannula at the Conventional Oxygen Therapy Phase in the Emergency Department

Authors
 Younghoon Kang  ;  Hae Min Jung  ;  Sung Phil Chung  ;  Hyun Soo Chung  ;  Yongtak Cho 
Citation
 RESPIRATION, Vol.103(8) : 488-495, 2024-08 
Journal Title
RESPIRATION
ISSN
 0025-7931 
Issue Date
2024-08
MeSH
Aged ; Aged, 80 and over ; Cannula* ; Emergency Service, Hospital* ; Female ; Humans ; Male ; Middle Aged ; Oximetry* ; Oxygen Inhalation Therapy* / instrumentation ; Oxygen Inhalation Therapy* / methods ; Oxygen Saturation ; ROC Curve ; Respiratory Insufficiency* / therapy ; Respiratory Rate ; Retrospective Studies ; Treatment Failure
Keywords
Acute respiratory failure ; Emergency department ; High-flow nasal cannula
Abstract
Introduction: The use of high-flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure has been increasing in the emergency department (ED). However, studies are lacking on the prediction of HFNC failure before therapy initiation in the ED. We investigated whether the existing indices, such as the ratio of pulse oximetry oxygen saturation/fraction of inspired oxygen to respiratory rate (ROX) and ratio of ROX index to heart rate (ROX-HR), can accurately predict HFNC failure at the conventional oxygen therapy phase in the ED.

Methods: This retrospective single-center study included patients treated with HFNC in the ED. The ROX and ROX-HR indices were calculated before initiating HFNC. An estimated fraction of inspired oxygen was used for conventional oxygen therapy. We plotted each index's receiver operating characteristics curve and calculated the area under the curve (AUC) for diagnostic capacity. The optimal cutoff values were assessed using the Youden index. The primary outcome was HFNC failure, defined as intubation in the ED.

Results: Among the 97 included patients, 25 (25.8%) failed HFNC therapy in the ED. The ROX and ROX-HR indices measured before initiating HFNC showed AUCs of 0.709 and 0.754, respectively. A ROX index of <5.614 and a ROX-HR index of <6.152 were associated with a high risk of intubation, even after correcting for confounding variables.

Conclusion: The ROX and ROX-HR indices measured before initiating HFNC provide a relatively fair predictive value of HFNC failure in the ED.
Full Text
https://karger.com/res/article-abstract/103/8/488/909701/Failure-Prediction-of-High-Flow-Nasal-Cannula-at?redirectedFrom=fulltext
DOI
10.1159/000540004
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Cho, Yongtak(조용탁)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/202193
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