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Analysis of ROX Index, ROX-HR Index, and SpO 2 /FIO 2 Ratio in Patients Who Received HighFlow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit
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Sun Hee Choi, Dong Yeon Kim, Byung Yun Song, Yang Sook Yoo
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J Korean Acad Nurs 2023;53(4):468-479. Published online August 31, 2023
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DOI: https://doi.org/10.4040/jkan.22152
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 Abstract
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- Purpose
This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit.
Methods
A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ2 test, Mann–Whitney U test, and area under the curve (AUC).
Results
Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption.
Conclusion
The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.
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Citations
Citations to this article as recorded by  - Admission Respiratory Rate-Oxygenation Index and Outcome of Acute Respiratory Illness in a Pediatric Intensive Care Unit
Vijendra Singh, Umesh Pandwar, Navindana ., Manjusha Goel
Cureus.2026;[Epub] CrossRef - Non-invasive SpO2/FiO2 ratio (SFR) as surrogate for PaO2/FiO2 ratio (PFR): A scoping review
Madhura Reddy, Malavika Kulkarni, Sushma Thimmaiah Kanakalakshmi, Laxmi Shenoy, Rama Rani KrishnaBhat
The Journal of Critical Care Medicine.2025; 11(3): 221. CrossRef - Can the ROX index predict high‐flow nasal cannula failure in children under 2 with lower respiratory tract infection?
Pablo Vasquez‐Hoyos, Alvaro L. Jacome‐Orozco, Andrea P. Rodriguez‐Mayorga, Leidy E. Sepulveda‐Forero, Diana P. Escobar‐Serna, Juan S. Barajas, Evelyn Obando‐Belalcazar, Claudia M. Salinas‐Jaimes, Juan J. Peralta‐Palmezano, Alexandra Jimenez‐Chavez, Rafael
Pediatric Pulmonology.2024; 59(5): 1246. CrossRef - Impact of Surgical Mask Placement Over High-Flow Nasal Cannula on Oxygenation Parameters in COVID-19 Patients Experiencing Hypoxemic Respiratory Failure
Aadila Coatwala, Mayank Dhir, Sagar Sinha, Dattatray Bhusare
Cureus.2024;[Epub] CrossRef
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Adapting existing guidelines to develop an evidence-based just culture decision-making guideline: a methodological study
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Byung Yun Song, Dong Yeon Kim, Su Yeon Hong, Nack-Gyun Chung, Hyun Hye Woo
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Received April 13, 2026 Accepted September 19, 2026 Published online October 12, 2026
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DOI: https://doi.org/10.4040/jkan.26053
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Abstract
 ePub
- Purpose
This study aimed to develop an evidence-based just culture decision-making guideline for the Korean healthcare context by systematically adapting existing international guidelines.
Methods
From March 2025 to February 2026, this methodological study followed a guideline adaptation framework comprising three phases, nine modules, and 24 steps. The process involved establishing development committees; formulating key questions using the patient population, intervention, professionals/patients, outcomes, and healthcare setting framework; systematically searching for and appraising international guidelines; assessing guideline quality through independent review using the Appraisal of Guidelines for Research and Evaluation II instrument; adapting recommendations; and obtaining external review by potential users and patient safety experts. Reviewers resolved disagreements through discussion and consensus.
Results
The final guideline contained 41 recommendations in five domains: the concept of just culture, principles for using the just culture decision-making tool, the just culture decision-making tool, follow-up actions, and support and learning. External review of the recommendations’ understandability, appropriateness, and applicability informed their refinement, followed by expert consensus. Evidence was classified as level II, level III, or a legal and regulatory basis; recommendation strengths were classified as A, B, or C.
Conclusion
This study provides a just culture decision-making framework specific to Korean healthcare organizations. The guideline is expected to support fair and reliable responses to patient safety incidents and promote a shift from individual blame toward organizational learning and system-based improvement.
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