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    ROX Index for Intubation after HFNC

    Predicts high-flow nasal cannula (HFNC) failure/need for intubation.
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    IMPORTANT

    Launched during COVID-19 crisis. COVID-19 Resource Center.

    INSTRUCTIONS

    In the original paper, patients started on HFNC were reassessed at 2, 6, and 12 hours; patients whose scores were in the "indeterminate" range (3.85-4.87) were reassessed two hours later. These scores were trended over time in patients.

    When to Use
    Pearls/Pitfalls
    Why Use

    After HFNC during reassessment, the ROX Index can help suggest which patients will fail HFNC and need to progress to intubation for further ventilatory support.

    • See our table below for common estimates of FiO₂ based on oxygen delivery device and oxygen flow rates.

    • A higher index is "better," as it suggests a better oxygen saturation, a lower FiO₂ requirement, and/or less tachypnea.

    While not externally validated, the ROX Index is a simple bedside calculation using three clinical variables and is one easy way to summarize a patient's degree of hypoxemic respiratory failure; it was created and studied to predict need for intubation post-HFNC, which is of particular importance in COVID-19.

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      Dr. Oriol Roca
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