Virginie Lemiale1, Guillaume Dumas2, Alexandre Demoule3, Frederic Pène4, Achille Kouatchet5, Magali Bisbal6, Saad Nseir7, Laurent Argaud8, Loay Kontar9, Kada Klouche10, Francois Barbier11, Amelie Seguin12, Guillaume Louis13, Jean-Michel Constantin14, Julien Mayaux3, Florent Wallet15, Vincent Peigne16, Christophe Girault17, Johanna Oziel18, Martine Nyunga19, Nicolas Terzi20, Lila Bouadma21, Alexandre Lautrette22, Naike Bige23, Jean-Herle Raphalen24, Laurent Papazian25, Fabrice Bruneel26, Christine Lebert27, Dominique Benoit28, Anne-Pascale Meert29, Samir Jaber30, Djamel Mokart6, Michael Darmon2, Elie Azoulay2. 1. AP-HP, Hôpital Saint-Louis, Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France. virginie.lemiale@sls.aphp.fr. 2. AP-HP, Hôpital Saint-Louis, Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France. 3. Medical Intensive Care Unit and Respiratory Division, APHP, Hopital Pitie-Salpetriere, Sorbonne University, Paris, France. 4. Medical Intensive Care Unit, Hospital Cochin, APHP, Universite Paris Descartes, Paris, France. 5. Medical Intensive Care Unit, CHRU, Angers, France. 6. Intensive Care Unit, Paoli Calmettes Institute, Marseille, France. 7. Critical Care Center, CHU de Lille, Lille, France. 8. Medical Intensive Care Unit, Hospices Civils de Lyon, Hopital Edouard Herriot, Lyon, France. 9. Medical Intensive Care Unit, INSERM U1088, Amiens University Hospital, Amiens, France. 10. Medical Intensive Care Unit, CHU de Montpellier, Montpellier, France. 11. Medical Intensive Care Unit, La Source Hospital, CHR Orleans, Orleans, France. 12. Medical Intensive Care Unit, Hotel Dieu, CHU de Nantes, Nantes, France. 13. Intensive Care Unit, CHR de Metz-Thionville, Metz, France. 14. Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France. 15. Intensive Care Unit, Lyon Sud Medical Center, Lyon, France. 16. Intensive Care Unit, Centre Hospitalier Metropole-Savoie, Chambery, France. 17. Medical Intensive Care Unit, Hospital Charles Nicolle, Rouen, France. 18. Medical Intensive Care Unit, Avicenne University Hospital, Bobigny, France. 19. Intensive Care Unit, Roubaix Hospital, Roubaix, France. 20. Medical Intensive Care Unit, CHU de Grenoble Alpes, Grenoble, France. 21. Medical Intensive Care Unit, CHU Bichat, Paris, France. 22. Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France. 23. Medical Intensive Care Unit, CHU St-Antoine, Paris, France. 24. Department of Anesthesia and Critical Care, Necker Hospital, Paris, France. 25. Reanimation Des Detresses Respiratoires Et Infections Severes, Assistance Publique-Hopitaux de Marseille, Hopital Nord, Faculte de Medecine, Aix-Marseille Universite, Marseille, France. 26. Medical Intensive Care Unit, Andre Mignot Hospital, Versailles, France. 27. Intensive Care Unit, Centre Hospitalier Departemental Les Oudairies, La Roche Sur Yon, France. 28. Department of Intensive Care, Ghent University Hospital, Ghent, Belgium. 29. Service de Médecine Interne, Soins Intensifs & Urgences Oncologiques, Institut Jules Bordet, Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium. 30. Montpellier University Hospital, PhyMedExp, INSERM U-1046, CNRS, 34295, Montpellier, France.
Abstract
BACKGROUND: Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. RESULTS: In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1-3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69-7.01) vs. 6.10 (4.48-8.68), p < 0.001]. The accuracy of the ROX index to predict intubation was poor [AUC = 0.623 (0.557-0.689)], with low performance using the threshold previously found (4.88). In multivariate analysis, a higher ROX index was still independently associated with a lower intubation rate (OR = 0.89 [0.82-0.96], p = 0.04). CONCLUSION: A ROX index greater than 4.88 appears to have a poor ability to predict intubation in immunocompromised patients with acute respiratory failure, although it remains highly associated with the risk of intubation and may be useful to stratify such risk in future studies.
BACKGROUND: Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. RESULTS: In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1-3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69-7.01) vs. 6.10 (4.48-8.68), p < 0.001]. The accuracy of the ROX index to predict intubation was poor [AUC = 0.623 (0.557-0.689)], with low performance using the threshold previously found (4.88). In multivariate analysis, a higher ROX index was still independently associated with a lower intubation rate (OR = 0.89 [0.82-0.96], p = 0.04). CONCLUSION: A ROX index greater than 4.88 appears to have a poor ability to predict intubation in immunocompromised patients with acute respiratory failure, although it remains highly associated with the risk of intubation and may be useful to stratify such risk in future studies.