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Abstract
BACKGROUND: 
may be a reliable noninvasive alternative to the 
index. Furthermore, the ROX index (ie, the ratio of 
to breathing frequency) has been validated to predict high-flow nasal cannula failure in subjects under spontaneous breathing. However, these indices have not been tested in subjects with COVID-19 receiving invasive mechanical ventilation. This study aims to verify the correlation between both the ROX index and 
with 
and the ratio of 
to breathing frequency, and to determine the accuracy of the indices that use 
for the prediction of extubation failure in subjects with COVID-19.
METHODS: A prospective cohort study was conducted from May 15, 2020, to June 15, 2020, with subjects with COVID-19 on invasive mechanical ventilation. Indices using 
in the formula were compared to those using 
. Additionally, the performance of the indices in predicting extubation failure was evaluated.
RESULTS: This study included 69 subjects age 64.8 ± 14.6 y. There were no differences between the median values of the indices, including between the ROX index and 
to breathing frequency (P = .40) or between 
and 
(P = .83). When comparing the ROX index with the 
index to breathing frequency, they were found to be strongly correlated (R2 = 0.75 [95% CI 0.6763–0.8152], P < .001). The comparison of 
with 
revealed R2 = 0.70 (95% CI 0.563–0.749, P < .001). The area under the receiver operating characteristic curve for the ROX index to determine extubation failure was 0.74 (P = .01), whereas for 
it was 0.78 (P < .001).
CONCLUSIONS: The indices presented a good correlation in subjects with COVID-19 on invasive mechanical ventilation, and both the ROX index and 
can discriminate extubation failure in this population.
Footnotes
- Correspondence: João Manoel Silva Jr MD PhD, Anesthesiology Division, Central Institute, University of São Paulo, Faculty of Medicine Clinics Hospital, 05403–000 São Paulo, Brazil. E-mail: joao.s{at}usp.br
The authors have disclosed no conflicts of interest.
- Copyright © 2021 by Daedalus Enterprises
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