RT Journal Article SR Electronic T1 High-Flow Nasal Cannula Therapy in COVID-19: Using the ROX Index to Predict Success JF Respiratory Care FD American Association for Respiratory Care SP 909 OP 919 DO 10.4187/respcare.08631 VO 66 IS 6 A1 Abhimanyu Chandel A1 Saloni Patolia A1 A Whitney Brown A1 A Claire Collins A1 Dhwani Sahjwani A1 Vikramjit Khangoora A1 Paula C Cameron A1 Mehul Desai A1 Aditya Kasarabada A1 Jack K Kilcullen A1 Steven D Nathan A1 Christopher S King YR 2021 UL http://rc.rcjournal.com/content/66/6/909.abstract AB BACKGROUND: Optimal timing of mechanical ventilation in COVID-19 is uncertain. We sought to evaluate outcomes of delayed intubation and examine the ROX index (ie, [ ]/breathing frequency) to predict weaning from high-flow nasal cannula (HFNC) in patients with COVID-19.METHODS: We performed a multicenter, retrospective, observational cohort study of subjects with respiratory failure due to COVID-19 and managed with HFNC. The ROX index was applied to predict HFNC success. Subjects that failed HFNC were divided into early HFNC failure (≤ 48 h of HFNC therapy prior to mechanical ventilation) and late failure (> 48 h). Standard statistical comparisons and regression analyses were used to compare overall hospital mortality and secondary end points, including time-specific mortality, need for extracorporeal membrane oxygenation, and ICU length of stay between early and late failure groups.RESULTS: 272 subjects with COVID-19 were managed with HFNC. One hundred sixty-four (60.3%) were successfully weaned from HFNC, and 111 (67.7%) of those weaned were managed solely in non-ICU settings. ROX index >3.0 at 2, 6, and 12 hours after initiation of HFNC was 85.3% sensitive for identifying subsequent HFNC success. One hundred eight subjects were intubated for failure of HFNC (61 early failures and 47 late failures). Mortality after HFNC failure was high (45.4%). There was no statistical difference in hospital mortality (39.3% vs 53.2%, P = .18) or any of the secondary end points between early and late HFNC failure groups. This remained true even when adjusted for covariates.CONCLUSIONS: In this retrospective review, HFNC was a viable strategy and mechanical ventilation was unecessary in the majority of subjects. In the minority that progressed to mechanical ventilation, duration of HFNC did not differentiate subjects with worse clinical outcomes. The ROX index was sensitive for the identification of subjects successfully weaned from HFNC. Prospective studies in COVID-19 are warranted to confirm these findings and to optimize patient selection for use of HFNC in this disease.