{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T21:53:24Z","timestamp":1787003604414,"version":"build-2736575974"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    High-flow nasal cannula (HFNC) is a relatively recent therapy that has been used to treat respiratory failure. Until now, the criterion for failure requiring escalation to other forms of ventilatory support has remained unclear. This study evaluated how the ROX index predicts the success or failure of HFNC in infants with bronchiolitis. A prospective, observational, multicenter study was conducted in 2 pediatric ICUs. The data were collected at 7 moments. Patients were categorized into failure and success groups according to HFNC. A total of 102 infants were included, 18(17.6%) of whom failed HFNC therapy. For the ROX index, significant differences were observed between the failure 5.8(95%CI 4.7\u20137.1) and success 7.7(95%CI 7.2\u20138.2) groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.005) at the 12\u00a0h evaluation. According to the analysis of the performance of the ROX index, the AUC at 12\u00a0h was 0.716(95%CI 0.591\u20130.842;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.016). The best cutoff range for the ROX index at 12\u00a0h was 6.50\u20137.18, with a sensitivity of 42% and a specificity of 66% at the cutoff of 6.50, and a sensitivity of 92% and a specificity of 54% at the cutoff of 7.18. We concluded that the ROX index could be effective at predicting the failure of HFNC therapy in infants with bronchiolitis beginning at 12\u00a0h after installation.\n                  <\/jats:p>","DOI":"10.1038\/s41598-024-51214-4","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T13:01:59Z","timestamp":1704286919000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["ROX index as a predictor of failure of high-flow nasal cannula in infants with bronchiolitis"],"prefix":"10.1038","volume":"14","author":[{"given":"Milena Siciliano","family":"Nascimento","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Agostini","family":"Z\u00f3lio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Assis Pires Andrade","family":"Vale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia Angelica de Lima","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thereza Silva","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise Helena Rodrigues","family":"Gon\u00e7alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linus Pauling","family":"Fascina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiane","family":"do Prado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,3]]},"reference":[{"key":"51214_CR1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jped.2017.06.006","volume":"93","author":"KN Slain","year":"2017","unstructured":"Slain, K. N., Shein, S. L. & Rotta, A. T. The use of high-flow nasal cannula in the pediatric emergency department. J. Pediatr. 93, 36\u201345 (2017).","journal-title":"J. Pediatr."},{"key":"51214_CR2","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12887-015-0501-x","volume":"15","author":"D Franklin","year":"2015","unstructured":"Franklin, D. et al. Early high flow nasal cannula therapy in bronchiolitis, a prospective randomized control trial (protocol): A pediatric acute respiratory intervention study (PARIS). BMC Pediatr. 15, 183 (2015).","journal-title":"BMC Pediatr."},{"key":"51214_CR3","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13613-014-0029-5","volume":"4","author":"C Mil\u00e9si","year":"2014","unstructured":"Mil\u00e9si, C. et al. High-flow nasal cannula: Recommendations for daily practice in pediatrics. Ann. Intensive Care 4, 29 (2014).","journal-title":"Ann. Intensive Care"},{"key":"51214_CR4","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1136\/archdischild-2018-315846","volume":"104","author":"J Lin","year":"2019","unstructured":"Lin, J. et al. High-flow nasal cannula therapy for children with bronchiolitis: A systematic review and meta-analysis. Arch. Dis. Child. 104, 564\u2013576 (2019).","journal-title":"Arch. Dis. Child."},{"key":"51214_CR5","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1111\/jpc.13564","volume":"53","author":"CT Goh","year":"2017","unstructured":"Goh, C. T., Kirby, L. J., Schell, D. N. & Egan, J. R. Humidified high-flow nasal cannula oxygen in bronchiolitis reduces need for invasive ventilation but not intensive care admission. J. Paediatr. Child Health 53, 897\u2013902 (2017).","journal-title":"J. Paediatr. Child Health"},{"issue":"5","key":"51214_CR6","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1007\/s00134-011-2177-5","volume":"37","author":"A Schibler","year":"2011","unstructured":"Schibler, A. et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med. 37(5), 847\u2013852 (2011).","journal-title":"Intensive Care Med."},{"key":"51214_CR7","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.jcrc.2017.09.003","volume":"44","author":"F Kamit Can","year":"2018","unstructured":"Kamit Can, F. et al. Predictive factors for the outcome of high flow nasal cannula therapy in a pediatric intensive care unit: Is the SpO2\/FiO2 ratio useful?. J. Crit. Care 44, 436\u2013444 (2018).","journal-title":"J. Crit. Care"},{"issue":"1","key":"51214_CR8","first-page":"71","volume":"12","author":"G Iplik","year":"2021","unstructured":"Iplik, G., Yildizdas, D. & Yontem, A. Clinical factors of high-flow nasal cannula oxygen success in children. J. Pediatr. Intensive Care 12(1), 71\u201378 (2021).","journal-title":"J. Pediatr. Intensive Care"},{"issue":"3","key":"51214_CR9","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.arcped.2018.01.003","volume":"25","author":"C Guillot","year":"2018","unstructured":"Guillot, C. et al. First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure. Arch. Pediatr. 25(3), 213\u2013218 (2018).","journal-title":"Arch. Pediatr."},{"key":"51214_CR10","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jcrc.2016.05.022","volume":"35","author":"O Roca","year":"2016","unstructured":"Roca, O. et al. 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\u2013205 (2016).","journal-title":"J. Crit. Care"},{"key":"51214_CR11","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.jcrc.2019.08.013","volume":"58","author":"E Spinelli","year":"2019","unstructured":"Spinelli, E., Roca, O. & Mauri, T. Dynamic assessment of the ROX index during nasal high flow for early identification of nonresponders. J. Crit. Care 58, 130 (2019).","journal-title":"J. Crit. Care"},{"issue":"41","key":"51214_CR12","first-page":"1","volume":"8","author":"KJ Goh","year":"2020","unstructured":"Goh, K. J. et al. Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. J. Intensive Care 8(41), 1\u201314 (2020).","journal-title":"J. Intensive Care"},{"key":"51214_CR13","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s12890-022-02017-8","volume":"22","author":"Z Li","year":"2022","unstructured":"Li, Z. et al. Prediction of high-flow nasal cannula outcomes at the early phase using the modified respiratory rate oxygenation index. BMC Pulm. Med. 22, 227 (2022).","journal-title":"BMC Pulm. Med."},{"key":"51214_CR14","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.jcrc.2021.08.012","volume":"66","author":"J Prakash","year":"2021","unstructured":"Prakash, J. et al. ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. J. Crit. Care 66, 102\u2013108 (2021).","journal-title":"J. Crit. Care"},{"issue":"1","key":"51214_CR15","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s12890-022-01914-2","volume":"22","author":"X Zhou","year":"2022","unstructured":"Zhou, X., Liu, J., Pan, J., Xu, Z. & Xu, J. The ROX index as a predictor of high-flow nasal cannula outcome in pneumonia patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. BMC Pulm. Med. 22(1), 121 (2022).","journal-title":"BMC Pulm. Med."},{"issue":"1","key":"51214_CR16","doi-asserted-by":"publisher","first-page":"e15336","DOI":"10.1111\/ped.15336","volume":"64","author":"JH Kim","year":"2022","unstructured":"Kim, J. H., Suh, D. I. & Park, J. D. S\/F and ROX indices in predicting failure of high-flow nasal cannula in children. Pediatr Int. 64(1), e15336 (2022).","journal-title":"Pediatr Int."},{"issue":"11","key":"51214_CR17","doi-asserted-by":"publisher","first-page":"3977","DOI":"10.1007\/s00431-022-04607-4","volume":"181","author":"N Kannikeswaran","year":"2022","unstructured":"Kannikeswaran, N., Whittaker, P. & Sethuraman, U. Association between respiratory rate oxygenation index and need for positive pressure ventilation in children on high flow nasal cannula for bronchiolitis. Eur. J. Pediatr. 181(11), 3977\u20133983 (2022).","journal-title":"Eur. J. Pediatr."},{"issue":"1","key":"51214_CR18","first-page":"26","volume":"25","author":"RFC Paes","year":"2002","unstructured":"Paes, R. F. C., Percebo, A., Naspitz, C. K. & Sol\u00e9, D. Clinical severity score in the evaluation of acute attacks of asthma in children. Rev. Bras. Alerg. Imunopatol. 25(1), 26\u201340 (2002).","journal-title":"Rev. Bras. Alerg. Imunopatol."},{"issue":"4","key":"51214_CR19","first-page":"122","volume":"25","author":"RFC Paes","year":"2002","unstructured":"Paes, R. F. C., Percebo, A., Naspitz, C. K. & Sol\u00e9, D. Scores of acute dyspnea and wheezing episodes in children: Validation of the Wood\u2013Downes and Ben-Zvi\u2019s scores. Rev. Bras. Alerg. Imunopatol. 25(4), 122\u2013130 (2002).","journal-title":"Rev. Bras. Alerg. Imunopatol."},{"key":"51214_CR20","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1007\/s00134-002-1601-2","volume":"29","author":"A Slater","year":"2003","unstructured":"Slater, A., Shann, F. & Pearson, G. Pediatric Index of Mortality (PIM) study group. PIM2: A revised version of the Pediatric Index of Mortality. Intensive Care Med. 29, 278\u201385 (2003).","journal-title":"Intensive Care Med."},{"key":"51214_CR21","volume-title":"Practical Statistics for Medical Research","author":"DG Altman","year":"1991","unstructured":"Altman, D. G. Practical Statistics for Medical Research (CRC Press, 1991)."},{"key":"51214_CR22","unstructured":"Faraway, J. J. Extending the linear model with R: Generalized linear, mixed effects and nonparametric regression models (2006)."},{"issue":"1","key":"51214_CR23","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","volume":"3","author":"WJ Youden","year":"1950","unstructured":"Youden, W. J. Index for rating diagnostic tests. Cancer 3(1), 32\u201335 (1950).","journal-title":"Cancer"},{"key":"51214_CR24","unstructured":"IBM Corp. IBM SPSS Statistics for Windows, Version 24.0 (2016)."},{"key":"51214_CR25","unstructured":"R Core Team. R: A language and environment for statistical computing (2015). http:\/\/www.R-project.org\/."},{"key":"51214_CR26","doi-asserted-by":"publisher","first-page":"eAO5846","DOI":"10.31744\/einstein_journal\/2021AO5846","volume":"19","author":"MS Nascimento","year":"2021","unstructured":"Nascimento, M. S. et al. High-flow nasal cannula failure: Can clinical outcomes determine early interruption?. Einstein (Sao Paulo) 19, eAO5846. https:\/\/doi.org\/10.31744\/einstein_journal\/2021AO5846 (2021).","journal-title":"Einstein (Sao Paulo)"},{"issue":"6","key":"51214_CR27","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1002\/ppul.23981","volume":"53","author":"A Er","year":"2018","unstructured":"Er, A. et al. Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department. Pediatr. Pulmonol. 53(6), 809\u2013815 (2018).","journal-title":"Pediatr. Pulmonol."},{"issue":"4","key":"51214_CR28","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00431-020-03847-6","volume":"180","author":"D Yildizdas","year":"2021","unstructured":"Yildizdas, D., Yontem, A., Iplik, G., Horoz, O. O. & Ekinci, F. 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(4), 1099\u20131106 (2021).","journal-title":"Eur. J. Pediatr."},{"key":"51214_CR29","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1002\/ppul.21482","volume":"46","author":"RC Dohna-Schwake","year":"2011","unstructured":"Dohna-Schwake, R. C. et al. Noninvasive ventilation on a pediatric intensive care unit: Feasibility, efficacy, and predictors of success. Pediatr. Pulmonol. 46, 1114\u20131120 (2011).","journal-title":"Pediatr. Pulmonol."},{"issue":"4","key":"51214_CR30","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1097\/01.PCC.0000225089.21176.0B","volume":"7","author":"S Essouri","year":"2006","unstructured":"Essouri, S. et al. Noninvasive positive pressure ventilation: Five years of experience in a pediatric intensive care unit. Pediatr. Crit. Care Med. 7(4), 329\u2013334 (2006).","journal-title":"Pediatr. Crit. Care Med."},{"key":"51214_CR31","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.1056\/NEJMoa032736","volume":"350","author":"A Esteban","year":"2006","unstructured":"Esteban, A. et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N. Engl. J. Med 350, 2452\u20132460 (2006).","journal-title":"N. Engl. J. Med"},{"issue":"12","key":"51214_CR32","doi-asserted-by":"publisher","first-page":"595","DOI":"10.3345\/cep.2022.00241","volume":"65","author":"K Saelim","year":"2022","unstructured":"Saelim, K., Thirapaleka, B., Ruangnapa, K., Prasertsan, P. & Anuntaseree, W. Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress. Clin. Exp. Pediatr. 65(12), 595\u2013601 (2022).","journal-title":"Clin. Exp. Pediatr."},{"issue":"1","key":"51214_CR33","doi-asserted-by":"publisher","first-page":"15914","DOI":"10.1038\/s41598-020-72687-z","volume":"10","author":"MS Nascimento","year":"2020","unstructured":"Nascimento, M. S., Quinto, D. E. R., Oliveira, G. C. Z., Rebello, C. M. & do Prado, C. Nasogastric tube, a warning sign for high-flow nasal cannula failure in infants with bronchiolitis. Sci. Rep. 10(1), 15914 (2020).","journal-title":"Sci. Rep."},{"issue":"8","key":"51214_CR34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s40560-020-00458-z","volume":"22","author":"KJ Goh","year":"2020","unstructured":"Goh, K. J. et al. Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. J. Intensive Care. 22(8), 41 (2020).","journal-title":"J. Intensive Care."},{"key":"51214_CR35","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.09765","author":"LV Webb","year":"2022","unstructured":"Webb, L. V., Chahine, R., Aban, I., Prabhakaran, P. & Loberger, J. M. Predicting high-flow nasal cannula therapy outcomes using the ROX-HR Index in the pediatric ICU. Respir. Care https:\/\/doi.org\/10.4187\/respcare.09765 (2022).","journal-title":"Respir. Care"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-51214-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-51214-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-51214-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T13:04:52Z","timestamp":1704287092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-51214-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,3]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["51214"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-51214-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,3]]},"assertion":[{"value":"18 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"389"}}