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Letter to the Editor
Use of the ROX index in the assessment of success of high-flow oxygen therapy in secondary hypoxemia to type 2 coronavirus
Utilización del índice de ROX en la valoración del éxito de oxigenoterapia de alto flujo en la hipoxemia secundaria a coronavirus tipo 2
A. González-Castroa, A. Fajardo Campoverdeb,
Corresponding author
drauriopiotr@gmail.com

Corresponding author.
, A. Roncalli Rochac, Grupo LATAM de ventilación mecánica (WeVent)
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Servicio de Medicina Interna – Unidad de Paciente Crítico, Viña del Mar, Chile
c Hospital Escola Helvio Auto Maceió, Maceió, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">High-flow nasal cannula &#40;HFNC&#41; provide high-flow oxygen&#8212;up to 60&#8239;L&#47;min&#8212;with FiO<span class="elsevierStyleInf">2</span> between 0&#46;21 and 1&#46; The potential benefits would be&#58; improved respiratory pattern with a lower respiratory rate &#40;RR&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">One variable suggested to assess success or failure is the ROX index &#40;ROXI&#41; that combines oxygenation &#40;SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#41; and respiratory effort &#40;RE&#41;&#46; Its validity in the management of COVID-19-related pneumonia has a high sensitivity to predict failed therapies&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and is associated with a high mortality rate &#40;45&#46;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding the denominator &#40;RE&#41; in the assessment of the ROXI&#44; the retrograde&#44; transcriptional&#44; and hematogenous neuronal dissemination have been reported as possible access routes used by SARS-CoV-2 to enter the central nervous system&#46; As a matter of fact&#44; respiratory and cardiovascular vital centers of the brainstem are potential targets for SARS-CoV-2&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Sensitivity changes to peripheral chemoreceptors of carotid bodies invaded by SARS-CoV-2 can lead to a disproportionate ventilatory response at hypoxia level&#46; Hyperexcitability can be developed in some cases and desensitization in others&#46; Therefore&#44; changes to the RE during the use of HFNC may not be associated directly with respiratory effort&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">During atypical acute respiratory distress syndrome &#40;ARDS&#41; due to SARS-CoV-2&#44; patients often show a relatively well-preserved pulmonary mechanism that is not consistent with the severity of hypoxemia&#46; To this point&#44; several mechanisms converge&#58; dysregulated pulmonary perfusion and hypoxic vasoconstriction&#44; &#8220;infectious toxic encephalopathy&#8221; &#40;central hypoxia&#41;&#44; and damage to the carotid body<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> that could also be a route of infection into the nervous system&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We believe that we should be cautious when using the ROX index only as a predictor of success or failure in these patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None whatsoever&#46;</p></span></span>"
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Article information
ISSN: 21735727
Original language: English
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