Early Changes in ROX Index Predicts Treatment Failure After Awake Prone Positioning in Acute Respiratory Failure: Study

A recent groundbreaking study
conducted on COVID-19 patients found the predictive value of the respiratory
rate-oxygenation (ROX) index in acute respiratory failure. The study found that changes in the ROX index after the
first awake-prone positioning session led to intubation and death as per the
findings published in the journal Intensive Care Medicine.

Proning is a method of treating
intubated and sedated patients by making them lie on their stomachs. During the
COVID-19 pandemic, many physicians found beneficial effects of treating individuals
in prone positions. However, the accurate physiological parameters that have to
be monitored after a session of awake-prone positioning in individuals with
acute respiratory failure are not known. Hence, researchers conducted a study
to identify the early physiologic changes that are linked to the need for
invasive mechanical ventilation or death in patients with acute respiratory
failure after the first session of awake-prone positioning.

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a secondary analysis of a
prospective cohort study was carried out by including adult patients with acute
respiratory failure related to coronavirus disease 2019 (COVID-19) treated with
awake prone positioning. the association between relative changes in
physiological variables such as oxygenation, respiratory rate, pCO2,
and respiratory rate-oxygenation [ROX] index was assessed within the first
6 h of the first awake prone positioning session with treatment failure. A
treatment was considered to be a failure when there arose a necessity for endotracheal
intubation and/or death within 7 days.

Findings:

  • About 244 patients that included 70 females
    (29%), with a mean age of 60 were included.
  • Nearly Seventy-one (29%) patients experienced awake-prone
    positioning failure.
  • ROX index was found to be the main physiologic
    predictor.
  • Patients with treatment failure had lower mean
    [SD] ROX index at baseline [5 (1.4) versus 6.6 (2.2), p < 0.0001]
    and within 6 h of prone positioning [5.6 (1.7) versus 8.7 (2.8), p < 0.0001].
  • After adjusting for baseline characteristics and
    severity, a relative increase of the ROX index compared to baseline was
    associated with lower odds of failure.
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Thus, the study concluded that the
ROX index was the main predictive factor for intubation and mortality in
individuals treated by awake-prone positioning.

Further reading: Olmos M,
Esperatti M, Fuentes N, et al. Early physiologic changes after awake prone
positioning predict clinical outcomes in patients with acute hypoxemic
respiratory failure. Intensive Care Med. Published online November
14, 2024. doi:10.1007/s00134-024-07690-3

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