Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rat
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ORIGINAL ARTICLE
Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children Dincer Yildizdas 1
&
Ahmet Yontem 1
&
Gokce Iplik 1
&
Ozden Ozgur Horoz 1
&
Faruk Ekinci 1
Received: 8 August 2020 / Revised: 7 October 2020 / Accepted: 13 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The primary objective of this study was to evaluate whether pediatric respiratory rate-oxygenation index (p-ROXI) and variation in pROXI (p-ROXV) can serve as objective markers in children with high-flow nasal cannula (HFNC) failure. In this prospective, singlecenter observational study, all patients who received HFNC therapy in the general pediatrics ward, pediatric intensive care unit, and the pediatric emergency department were included. High-flow nasal cannula success was achieved for 116 (88.5%) patients. At 24 h, if both p-ROXI and p-ROXV values were above the cutoff point (≥ 66.7 and ≥ 24.0, respectively), HFNC failure was 1.9% and 40.6% if both were below their values (p < 0.001). At 48 h of HFNC initiation, if both p-ROXI and p-ROXV values were above the cutoff point (≥ 65.1 and ≥ 24.6, respectively), HFNC failure was 0.0%; if both were below these values, HFNC failure was 100% (p < 0.001). Conclusion: We observed that these parameters can be used as good markers in pediatric clinics to predict the risk of HFNC failure in patients with acute respiratory failure. What is Known: • Optimal timing for transitions between invasive and noninvasive ventilation strategies is of significant importance. • The complexity of data requires an objective marker that can be evaluated quickly and easily at the patient’s bedside for predicting HFNC failure in children with acute respiratory failure. What is New: • Our data showed that combining p-ROXI and p-ROXV can be successful in predicting HFNC failure at 24 and 48 h of therapy.
Keywords High-flow nasal cannula . Children . Acute respiratory failure . P-ROXI . P-ROXV Abbreviations AUROC Area under the ROC curve HFNC High-flow nasal cannula IMV Invasive mechanical ventilation NIMV Noninvasive mechanical ventilation
p-ROXI p ROXV SpO2
Pediatric respiratory rate-oxygenation index Variation in pediatric respiratory rate-oxygenation index Pulse oximetry
Communicated by Peter de Winter Communicated by Peter de Winter Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00431-020-03847-6) contains supplementary material, which is available to authorized users. * Ahmet Yontem [email protected]
Ozden Ozgur Horoz [email protected]
Dincer Yildizdas [email protected]
Faruk Ekinci [email protected]
Gokce Iplik [email protected]
1
Faculty of Medicine, Division of Pediatric Intensive Care Unit, Çukurova University, Sarıçam, Adana, Turkey
Eur J Pediatr
Introduction
Patients and definitions
While high-flow nasal cannula (HFNC) therapy is most commonly applied for infants with respiratory fail
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