Affiliation:
1. Dazhou Central Hospital
2. University of Electronic Science and Technology of China
3. the First Affiliated Hospital of Chongqing Medical University
Abstract
Abstract
Background
The Volume OXygeneration (VOX) index was initially designed to predict treatment failure of high-flow nasal cannula therapy. However, its predictive power for treatment failure in patients receiving non-invasive ventilation (NIV) remains uncertain.
Methods
This retrospective study was conducted across two centers from September 2017 to September 2021. Patients who underwent early NIV treatment were grouped based on their 2-hour NIV VOX Youden index. The low-risk group consisted of patients with a VOX index > 20.45 (n = 188), while the high-risk group included those with a VOX index ≤ 20.45 (n = 200). Baseline data and arterial blood gas values were collected at 2, 12, and 24 hours after NIV initiation.
Results
Compared to the low-risk group, the high-risk group exhibited higher SOFA scores, respiratory rates, and heart rates, along with a lower oxygenation index (P/F) (all P < 0.05). Following NIV treatment, the low-risk group showed a more significant increase in P/F values at 2 hours, 12 hours, and 24 hours after NIV initiation. Moreover, the low-risk group had a lower intubation rate (3.19% vs. 60%, P < 0.05) and mortality rate (4.79% vs. 17.5%, P < 0.05). At 2 hours of NIV, the area under the receiver operating characteristic curve for predicting NIV failure using the VOX index was 0.843 (95% CI 0.805–0.882). Using a VOX index threshold of 20.45 to predict NIV failure, the sensitivity was 69.1%, and the specificity was 94.4%. Furthermore, a VOX index ≤ 20.45 was identified as an independent risk factor for tracheal intubation and death.
Conclusions
In early NIV treatment for hypoxemic acute respiratory failure, the VOX index obtained after 2 hours of NIV demonstrates a strong predictive power for NIV failure. Patients with a VOX index > 20.45 have a low probability of NIV failure, suggesting that it can be used as an evaluation index to assess the efficacy of NIV.
Publisher
Research Square Platform LLC
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