Respiratory Rate-oxygenation Index Score in Corona Virus Disease 2019 (COVID-19) Patients Undergoing Non-invasive Mechanical Ventilation or High Flow Oxygen Supplementation
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RationalThe decision to move a coronavirus disease 19 (COVID-19) patient from non-invasive mechanical ventilation (NIMV) toinvasive mechanical ventilation (IMV) is difficult to make. The need of a score to identify patients failing NIMV early is vital. In thisstudy, we assessed the respiratory rate-oxygenation index (ROX) score in NIMV in patients with COVID-19.MethodsRetrospective study of adult patients admitted to our hospital with COVID-19 infection from May 2020 to February 2022.We included patients that were on high flow nasal cannula (HFNC) and/or BiPAP during hospitalization. The ROX scores werecalculated for those patients at 2, 6, and 12 hours after initiation of the NIMV. Our cohort was then divided into 2 groups: group 1were on HFNC while group 2 were on BiPAP. Primary outcomes included the need for mechanical ventilation and mortality.Descriptive statistics and Mann-Whitney U test tests were utilized to assess statistical significance. ResultsA cohort of 367patients was analyzed. 248 (67.6%25) patients were male, age 58.2 (±14.57) and BMI 29.7 [26.50-35.18]. A total of 160 (43.6%25)patients were on IMV, 197 (53.7%25) on HFNC, 68 (18.5%25) on BiPAP. The adjusted odds ratio (ORa) by age > 65 to receive IMVin group 1 for ROX <7 at 2 hours was 3.12 (95%25CI 1.46-6.70, p<0.001). The ORa to receive IMV in group 1 ROX <5.5 at 6 hourswas 3.13 (1.60-6.11, p<0.001). The ORa to receive IMV in group 1 ROX <3.50 at 12 hours was 3.68 (1.57-8.63, p=0.003). TheORa to receive IMV in group 2 ROX <4.5 at 2 hours was 2.89 (1.28-6.52, p=0.011). Despite these significant p-values, nostatistically significant threshold was associated with the probability of receiving IMV in Group 2 ROX at 6 and 12 hours. The ORaby age > 65 for death in group 1 ROX <7 at 2 hours was 2.43 (1.21-4.41, p=0.013). The ORa for death in group 1 ROX <5.5 at 6hours was 2.55 (1.33-4.87, p=0.005). The ORa for death in group 1 ROX <5 at 12 hours was 3.42 (1.43-8.23, p=0.006). Group 2ROX was not associated with death. ConclusionsHFNC-ROX at any point was associated with the need of IMV and death.However, BiPAP-ROX was associated with the need of IMV when measured at 2 hours only.
