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rates of 20–40 breaths/min using a range of FIO2 values from 0.4 to 1.0. The gray area indicates ROX values below a cutoff point of 4.88 (1). Respiratory rates in oxygen-dependent patients are expected to be increased. The figure reveals that the ROX index is unlikely to drop below 4.88 with FIO2 values of up to 0.5, and it would be under the cutoff point with FIO2 values of 0.8 or higher for the anticipated range of respiratory rates. FIO2 values of 0.5 and 0.8 are marked with interrupted vertical lines. If SpO2 is under or above 95%, all of the presented curves of the calculated ROX will shift slightly downward or upward, respectively. The index is very simple and has the potential to become a routine parameter in clinical practice when supplemental oxygen is used with NHF therapy. The presented figure may help to predict when a patient is expected to fail and could be considered for escalation of care. n

Success or Failure of High-Flow Nasal Oxygen Therapy: The ROX Index Is Good, but a Modified ROX Index May Be Better