TY - JOUR T1 - Early Variation of ROX Index Predicts High-Flow Nasal Cannula Outcome in Awake Subjects With Severe Hypoxemic COVID-19 JF - Respiratory Care SP - 110 LP - 113 DO - 10.4187/respcare.10125 VL - 68 IS - 1 AU - Fekri Abroug AU - Zeineb Hammouda AU - Manel Lahmar AU - Wiem Nouira AU - Syrine Maatouk AU - Sourour Belhaj Youssef AU - Fahmi Dachraoui AU - Laurent Brochard AU - Lamia Ouanes-Besbes Y1 - 2023/01/01 UR - http://rc.rcjournal.com/content/68/1/110.abstract N2 - A recent study1 in the United Kingdom with more than 20,000 subjects hospitalized for COVID-19–related acute respiratory failure (ARF) showed that high-flow nasal cannula (HFNC) was the most frequently used (55%) type of respiratory support, followed by noninvasive ventilation (NIV, 16%), whereas invasive mechanical ventilation was used in only 9% of subjects. A randomized controlled trial showed HFNC was beneficial in preventing intubation.2 However, another randomized controlled trial found CPAP as an initial oxygenation strategy was superior to standard oxygen therapy, whereas no differences were found compared to HFNC.3 However, these subjects were not ventilated in the prone position, which may potentiate the effect of NIV in awake subjects.4,5 Ehrmann et al6 recently showed in a multinational meta-trial that awake prone positioning reduced the risk of treatment failure and the need for intubation in subjects receiving HFNC for COVID-19–related ARF.In this context, early prediction of HFNC outcome may help with management of hypoxemic patients with COVID-19 regarding clinical decisions on optimal setting and magnitude of treatment. The ROX index, corresponding to the ratio of SpO2/FIO2 to breathing frequency, has been validated by Roca et al7 in subjects with ARF and pneumonia under HFNC, outside the COVID-19 context and without prone position. More recently, a few studies evaluated the ROX index in the setting of COVID-19–related ARF since prone position has become a standard of care.8-10 In this observational study, we assessed the performance of the ROX index calculated upon admission and its variation over the first 12 h in the prediction of HFNC failure in subjects with COVID-19–related ARF.This was a single-center observational study conducted between September 2020–July 2021. The study received the approval of the institutional review board under as usual … Correspondence: Fekri Abroug MD, ICU, CHU F.Bourguiba, 5000, Monastir, Tunisia. E-mail: fekri.abroug{at}gmail.com ER -