ROX指数预测急性呼吸衰竭患者气管插管时机的研究进展

Research Progress on the ROX Index for Predicting the Timing of Endotracheal Intubation in Patients with Acute Respiratory Failure

摘要: 急性呼吸衰竭患者气管插管的时机选择一直是临床面临的重大挑战，过早或延迟插管均会带来严重风险。ROX指数作为一个兼顾氧合与呼吸代偿状态的指标，不仅可动态监测，还便于获取，为这一困境提供了有价值的解决方案。本综述系统阐述了ROX指数在不同氧疗模式(如经鼻高流量氧疗、无创通气)及不同疾病人群(如COVID-19、COPD)中预测气管插管时机的效能。研究表明，ROX指数的动态变化趋势对治疗反应的评估比单次测量值更具预测价值，但其最佳阈值存在异质性，需结合具体临床情境进行个体化解读。尽管ROX指数在单独应用时存在局限，但若与其他变量甚至与机器学习相结合，构建多维度智能预警系统，则可以协助医师更早期、更精准地制定气管插管决策。

Abstract: Determining the optimal timing for endotracheal intubation in patients with acute respiratory failure remains a major clinical challenge, as both premature and delayed intubation can lead to serious risks. The ROX index, which integrates both oxygenation and respiratory compensation status, offers a valuable solution to this dilemma due to its suitability for dynamic monitoring and easy accessibility. This review systematically elaborates on the efficacy of the ROX index in predicting intubation timing across diverse respiratory support modalities (e.g., high-flow nasal cannula oxygen therapy, non-invasive ventilation), and various diseases (e.g., COVID-19, COPD). Studies indicate that the dynamic trend of the ROX index holds greater predictive value for assessing treatment response than single measurements. However, its optimal threshold exhibits heterogeneity and requires individualized interpretation based on specific clinical contexts. Although the ROX index has limitations when used alone, integrating it with other variables and machine learning to establish a multi-dimensional intelligent early-warning system could assist clinicians in making earlier and more accurate decisions regarding endotracheal intubation.