First 24-hour vital signs and scores.

ObjectiveTo assess a comparative analysis of the ROX index, Wood-Downes-Ferrés score (WDF), p-ROXI, and the SpO2/FiO2 ratio as predictors of high-flow nasal cannula (HFNC) failure in children hospitalized for bronchiolitis.MethodsData were extracted from the clinical trial “Comparison between HFNC and NIV in children with acute respiratory failure caused by bronchiolitis” conducted at a tertiary Brazilian hospital (Emergency Department and PICU). The inclusion criteria were children under 2 years of age admitted for bronchiolitis who developed mild to moderate respiratory distress and were eligible for HFNC therapy. Performance was determined by ROC and AUC metrics to define the best sensitivity and specificity for each variable. Children were evaluated at 0 h, 2 h, 6 h, 12 h, 24 h, 48 h, 72 h and 96 h after HFNC therapy initiation.ResultsA total of 126 patients were recruited for this analysis. The median age was 3 months. Ninety-one percent of the patients had an identified viral agent, with RSV being the most common (65%). Twenty-three percent (29/126) of patients experienced failed HFNC therapy and required mechanical ventilation. The best cutoff points at 12 hours were 4.5 for WDF (AUC = 0.83, 0.74–0.92), 8.8 for ROX (AUC = 0.7, 0.54–0.84), 1.45 for p-ROXI (AUC = 0.56, 0.38-0-74), and 269 for SpO2/FiO2 (AUC = 0.64, 0.48–0.74). The scores and indices were also correlated with the PICU and hospital LOS.ConclusionsThe ROX index and WDF were the most accurate scores for assessing HFNC failure considering 12-hour cutoff points.Trial registration numberU1111-1262-1740; RBR-104z966s. Date of registration: 03/01/2023.一、研究目的：本研究旨在对比分析ROX指数（ROX index）、Wood-Downes-Ferrés评分（Wood-Downes-Ferrés score, WDF）、p-ROXI以及SpO2/FiO2比值（SpO2/FiO2 ratio），作为儿童毛细支气管炎住院患者经鼻高流量氧疗（High-flow nasal cannula, HFNC）失败的预测因子的效能。 二、研究方法：本研究数据提取自一项在巴西三级医院（急诊科及儿科重症监护病房（Pediatric Intensive Care Unit, PICU））开展的临床试验《毛细支气管炎所致急性呼吸衰竭患儿经鼻高流量氧疗与无创通气（Non-invasive ventilation, NIV）对比研究》。纳入标准为因毛细支气管炎住院、出现轻至中度呼吸窘迫且符合经鼻高流量氧疗治疗指征的2岁以下儿童。采用受试者工作特征曲线（Receiver Operating Characteristic, ROC）及曲线下面积（Area Under the Curve, AUC）指标，确定各变量的最佳灵敏度与特异度。分别在经鼻高流量氧疗启动后0 h、2 h、6 h、12 h、24 h、48 h、72 h及96 h对患儿进行评估。 三、研究结果：本分析共纳入126例受试者，中位年龄为3个月。91%的患者检出病毒病原体，其中最常见的为呼吸道合胞病毒（Respiratory Syncytial Virus, RSV），占比65%。23%（29/126）的患者经鼻高流量氧疗治疗失败，需接受有创机械通气。12小时时的最佳截断值分别为：WDF评分4.5（AUC=0.83，95%置信区间0.74–0.92）、ROX指数8.8（AUC=0.7，95%置信区间0.54–0.84）、p-ROXI 1.45（AUC=0.56，95%置信区间0.38–0.74）以及SpO2/FiO2比值269（AUC=0.64，95%置信区间0.48–0.74）。上述评分及指标同时与儿科重症监护病房停留时长及总住院时长（length of stay, LOS）存在相关性。 四、研究结论：以12小时截断值为评估节点时，ROX指数与WDF评分是评估经鼻高流量氧疗失败的最准确预测指标。 五、试验注册信息：试验注册号：U1111-1262-1740；RBR-104z966s。注册日期：2023年1月3日。