An Integrated Model including the ROX Index to Predict the Success of High-Flow Nasal Cannula Use after Planned Extubation: A Retrospective Observational Cohort Study

High-flow nasal cannula (HFNC) therapy is commonly used to prevent reintubation after planned extubation. In clinical practice, there are no appropriate tools to evaluate whether HFNC therapy was successful or failed after planned extubation. In this retrospective observational study, we investigated whether the use of the ROX index was appropriate to differentiate between HFNC success and failure within 72 h after extubation and to develop an integrated model including the ROX index to improve the prediction of HFNC success in patients receiving HFNC therapy after planned extubation. Of 276 patients, 50 patients (18.1%) were reintubated within 72 h of extubation. ROX index values of >8.7 at 2 h, >8.7 at 6 h, and >10.4 at 12 h after HFNC therapy were all meaningful predictors of HFNC success in extubated patients. In addition, the integrated model including the ROX index had a better predictive capability for HFNC success than the ROX index alone. In conclusion, the ROX index at 2, 6, and 12 h could be applied to extubated patients to predict HFNC success after planned extubation. To improve its predictive power, we should also consider an integrated model consisting of the ROX index, sex, body mass index, and the total duration of ventilator care.

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High-Flow Nasal Cannula Therapy for the Management of Hypoxaemic Respiratory Failure in Patients with SARS-CoV-2 Pneumonia: An Observational Cohort Study

SSRN Electronic Journal ◽

10.2139/ssrn.3793561 ◽

2021 ◽

Author(s):

Adrian Palacios Chavarria ◽

Erika Salinas Lezama ◽

Mauricio Gonzalez Navarro ◽

Rafael Ricardo Valdez Vazquez ◽

Héctor Herrera Bello ◽

...

Keyword(s):

Cohort Study ◽

Respiratory Failure ◽

Observational Cohort Study ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Observational Cohort

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Is implementation of a hospital pathway for high-flow nasal cannula initiation and weaning associated with shorter treatment duration and length of hospital stay in bronchiolitis?

10.22541/au.163250541.10227706/v1 ◽

2021 ◽

Author(s):

Laura Tarantino ◽

Jason Burrows ◽

Nathaniel Goodrich ◽

Ellen Kerns ◽

Russell McCulloh

Keyword(s):

Linear Models ◽

Clinical Pathways ◽

Total Duration ◽

Length Of Hospital Stay ◽

Maximum Flow ◽

High Flow ◽

Nasal Cannula ◽

Hospital Length Of Stay ◽

High Flow Nasal Cannula ◽

Initial Flow

BACKGROUND: High-flow nasal cannula therapy (HFNC) is increasingly used for children with bronchiolitis, but its optimal role remains relatively uncertain. Our institution created and later revised a ward-based clinical pathway guiding initiation and weaning of HFNC. METHODS: A retrospective review of 664 encounters was conducted. Total duration of HFNC, duration of weaning from maximum flow rate, hospital length of stay (LOS), and escalation of care were compared across 3 study periods using generalized linear models: Baseline (HFNC managed at provider discretion, 5/1/2015-4/30/2017, n = 215), Intervention 1 (first pathway, initiation at 0.5 L/kg/min and escalation up to 2 L/kg/min, 5/1/2017-2/28/2018, n = 155), and Intervention 2 (revised pathway, initiation at the maximum rate of 2 L/kg/min, 3/1/2018-1/31/2020, n = 294). Both pathway iterations provided specific titration and weaning guidance. Models controlled for initial SpO2 and maximum respiratory rate to adjust for the possibility of differing case severity. RESULTS: After adjustment for severity, total duration of HFNC was significantly reduced in the second intervention, but not the first. Adjusted LOS was shorter in Intervention 1 and Intervention 2 compared to the baseline period. Adjusted weaning time and escalation of care did not differ significantly between periods. CONCLUSION: Pathway implementation was associated with modestly decreased LOS and – when initial flow rates were increased to 2 L/kg/min – reduced duration of HFNC, without differences in escalation of care or weaning time. These findings highlight the potential role of standardization of practice with clinical pathways in safely reducing unnecessary care.

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