RT Journal Article
SR Electronic
T1 Intubation Timing in COVID-19 Based on ROX Index and Association With Patient Outcomes
JF Respiratory Care
FD American Association for Respiratory Care
SP 1291
OP 1299
DO 10.4187/respcare.09937
VO 67
IS 10
A1 Michael T Vest
A1 Richard Caplan
A1 Mitch Fawcett
A1 Andrew R Deitchman
A1 Dominic Valentino
A1 Mithil Gajera
A1 Claudine T Jurkovitz
YR 2022
UL http://rc.rcjournal.com/content/67/10/1291.abstract
AB BACKGROUND: Timing of intubation in COVID-19 is controversial. We sought to determine the association of the ROX (Respiratory rate–OXygenation) index defined as divided by divided by breathing frequency at the time of intubation with clinical outcomes.METHODS: We conducted a retrospective cohort study of patients with COVID-19 who were intubated by using a database composed of electronic health record data from patients with COVID-19 from 62 institutions. Multivariable logistic regression was used to evaluate the impact of ROX index score on mortality. We analyzed the ROX index as a continuous variable as well as a categorical variable by using cutoffs previously described as predicting success with high-flow nasal cannula.RESULTS: Of 1,087 subjects in the analysis group, the median age was 64 years, and more than half had diabetes; 55.2% died, 1.8% were discharged to hospice, 7.8% were discharged to home, 27.3% were discharged to another institution, and 7.8% had another disposition. Increasing age and a longer time from admission to intubation were associated with mortality. After adjusting for sex, race, age, comorbidities, and days from admission to intubation, an increasing ROX index score at the time of intubation was associated with a lower risk of death. In a logistic regression model, each increase in the ROX index score by 1 at the time of intubation was associated with an 8% reduction in odds of mortality (odds ratio 0.92, 95% CI 0.88–0.95). We also found an odds ratio for death of 0.62 (95% CI 0.47–0.81) for subjects with an ROX index score ≥ 4.88 at the time of intubation.CONCLUSIONS: Among a cohort of subjects with COVID-19 who were ultimately intubated, a higher ROX index at the time of intubation was positively associated with survival.