Skip to main content

Advertisement

SpringerLink
Log in

Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The primary objective of this study was to evaluate whether pediatric respiratory rate-oxygenation index (p-ROXI) and variation in p-ROXI (p-ROXV) can serve as objective markers in children with high-flow nasal cannula (HFNC) failure. In this prospective, single-center 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AUROC:

Area under the ROC curve

HFNC:

High-flow nasal cannula

IMV:

Invasive mechanical ventilation

NIMV:

Noninvasive mechanical ventilation

p-ROXI:

Pediatric respiratory rate-oxygenation index

p-ROXV:

Variation in pediatric respiratory rate-oxygenation index

SpO2 :

Pulse oximetry

References

  1. Hough JL, Pham TM, Schibler A (2014) Physiologic effect of high-flow nasal cannula in infants with bronchiolitis. Pediatr Crit Care Med 15:214–219. https://doi.org/10.1097/PCC.0000000000000112

    Article  Google Scholar 

  2. Moreel L, Proesmans M (2020) High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review. Eur J Pediatr 179:711–718. https://doi.org/10.1007/s00431-020-03637-0

    Article  CAS  PubMed  Google Scholar 

  3. Shioji N, Iwasaki T, Kanazawa T, Shimizu K, Suemori T, Sugimoto K, Kuroe Y, Morimatsu H (2017) Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study. J Intensive Care 5:35. https://doi.org/10.1186/s40560-017-0226-z

    Article  PubMed  PubMed Central  Google Scholar 

  4. Richter RP, Alten JA, King RW, Gans AD, Rahman AF, Kalra Y, Borasino S (2019) Positive airway pressure versus high-flow nasal cannula for prevention of extubation failure in infants after congenital heart surgery. Pediatr Crit Care Med 20:149–157. https://doi.org/10.1097/PCC.0000000000001783

    Article  PubMed  Google Scholar 

  5. Colleti Junior J, Azevedo R, Araujo O, Carvalho WB (2020) High-flow nasal cannula as a post-extubation respiratory support strategy in preterm infants: a systematic review and meta-analysis. J Pediatr 96:422–431. https://doi.org/10.1016/j.jped.2019.11.004

    Article  Google Scholar 

  6. Marjanovic N, Flacher A, Drouet L, Le Gouhinec A, Said H, Vigneau JF, Chollet B, Lefebvre S, Sebbane M (2020) High-flow nasal cannula in early emergency department management of acute hypercapnic respiratory failure due to cardiogenic pulmonary edema. Respir Care 65:1241–1249. https://doi.org/10.4187/respcare.07278

    Article  PubMed  Google Scholar 

  7. Helviz Y, Einav S (2018) A systematic review of the high-flow nasal cannula for adult patients. Critical Care (London, England) 22:71. https://doi.org/10.1186/s13054-018-1990-4

    Article  Google Scholar 

  8. Roca O, Messika J, Caralt B, García-de-Acilu M, Sztrymf B, Ricard JD, Masclans JR (2016) Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care 35:200–205. https://doi.org/10.1016/j.jcrc.2016.05.022

    Article  PubMed  Google Scholar 

  9. Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G, García-de-Acilu M, Frat JP, Masclans JR, Ricard JD (2019) An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 199:1368–1376. https://doi.org/10.1164/rccm.201803-0589OC

    Article  PubMed  Google Scholar 

  10. Sepanski RJ, Godambe SA, Zaritsky AL (2018) Pediatric vital sign distribution derived from a multi-centered emergency department database. Front Pediatr 6:66. https://doi.org/10.3389/fped.2018.00066

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vásquez-Hoyos P, Jiménez-Chaves A, Tovar-Velásquez M, Albor-Ortega R, Palencia M, Redondo-Pastrana D, Díaz P, Roa-Giraldo JD (2019) Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude. Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud. Medicina intensiva. https://doi.org/10.1016/j.medin.2019.10.005

  12. Milési C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, Baleine J, Durand S, Combes C, Douillard A et al (2017) High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 43:209–216. https://doi.org/10.1007/s00134-016-4617-8

    Article  PubMed  Google Scholar 

  13. Lee WY, Choi EK, Shin J, Lee EH, Choi BM, Hong YS (2020) Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress. Pediatr Neonatol 61:174–179. https://doi.org/10.1016/j.pedneo.2019.09.004

    Article  PubMed  Google Scholar 

  14. Betters KA, Gillespie SE, Miller J, Kotzbauer D, Hebbar KB (2017) High flow nasal cannula use outside of the ICU; factors associated with failure. Pediatr Pulmonol 52:806–812. https://doi.org/10.1002/ppul.23626

    Article  PubMed  Google Scholar 

  15. Liu J, Li DY, Liu ZQ, Lu GY, Li XQ, Qiao LN (2019) High-risk factors for early failure of high-flow nasal cannula oxygen therapy in children. Zhongguo dang dai er ke za zhi = Chinese J Contemp Pediatr 21:650–655

    Google Scholar 

  16. Guillot C, Le Reun C, Behal H, Labreuche J, Recher M, Duhamel A, Leteurtre S (2018) First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: applicability and risk factors for failure. Arch de Pediatr 25:213–218. https://doi.org/10.1016/j.arcped.2018.01.003

    Article  CAS  Google Scholar 

  17. Karim H, Esquinas AM (2019) Success or failure of high-flow nasal oxygen therapy: the ROX index is good, but a modified ROX index may be better. Am J Respir Crit Care Med 200:116–117. https://doi.org/10.1164/rccm.201902-0419LE

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mauri T, Alban L, Turrini C, Cambiaghi B, Carlesso E, Taccone P, Bottino N, Lissoni A, Spadaro S, Volta CA, Gattinoni L, Pesenti A, Grasselli G (2017) Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med 43:1453–1463. https://doi.org/10.1007/s00134-017-4890-1

    Article  CAS  PubMed  Google Scholar 

  19. Mauri T, Carlesso E, Spinelli E, Turrini C, Corte FD, Russo R, Ricard JD, Pesenti A, Roca O, Grasselli G (2019) Increasing support by nasal high flow acutely modifies the ROX index in hypoxemic patients: a physiologic study. J Crit Care 53:183–185. https://doi.org/10.1016/j.jcrc.2019.06.020

    Article  PubMed  Google Scholar 

  20. Mauri T, Galazzi A, Binda F, Masciopinto L, Corcione N, Carlesso E, Lazzeri M, Spinelli E, Tubiolo D, Volta CA et al (2018) Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula. Critical Care (London, England) 22:120. https://doi.org/10.1186/s13054-018-2039-4

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Division of Pediatric Intensive Care Unit, Çukurova University, Sarıçam, Adana, Turkey

    Dincer Yildizdas, Ahmet Yontem, Gokce Iplik, Ozden Ozgur Horoz & Faruk Ekinci

Authors
  1. Dincer Yildizdas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmet Yontem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gokce Iplik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ozden Ozgur Horoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Faruk Ekinci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DY conceived and designed the study and critically reviewed the manuscript.

AY collected and analyzed the data and wrote the first draft of the manuscript.

GI collected the data and wrote a part of the first draft of the manuscript.

OOH acquired the data and critically reviewed the manuscript.

FE acquired the data and critically reviewed the manuscript.

Corresponding author

Correspondence to Ahmet Yontem.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Çukurova University Faculty of Medicine Non-Interventional Clinical Research Ethics Committee.

Informed consent

Informed consent was obtained from legal guardians.

Additional information

Communicated by Peter de Winter

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Communicated by Peter de Winter

Electronic supplementary material

ESM 1

(DOCX 15 kb)

ESM 2

(DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yildizdas, D., Yontem, A., Iplik, G. et al. Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children. Eur J Pediatr 180, 1099–1106 (2021). https://doi.org/10.1007/s00431-020-03847-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-020-03847-6

Keywords

Search

Navigation