Respiratory failure & ventilation
Impact of an ROX index-guided intubation strategy on mortality in patients receiving high-flow nasal cannula: a target trial emulation
Authors' conclusion
ROX-guided intubation strategies were associated with lower 30-day mortality than usual care.
Study context
- Population
- Adults initiated on high-flow nasal cannula (HFNC) within 7 days of intensive care unit (ICU) admission (Medical Information Mart for Intensive Care IV (MIMIC-IV))
- Participants
- 1,651 adults
- Comparison
- ROX-guided intubation vs usual care
- Outcome
- Estimated mortality
- Follow-up
- 30 days
Methodological detailsclone-censor-weighting, per-protocol effect, pooled logistic regression
- Clone-censor-weighting
- Per-protocol effect
- Pooled logistic regression
Main finding
As reported in the abstract
30-day mortality
Each group vs usual careRisk difference, percentage points (95% CI)
ROX < 3.85
−6.5(−9.1 to −3.8)
ROX < 4.88
−7.1(−10.3 to −3.5)
Time-varying ROX
−5.6(−7.9 to −3.4)
Each group vs usual careRelative risk (95% CI)
ROX < 3.85
0.76(0.66–0.86)
ROX < 4.88
0.74(0.62–0.87)
Time-varying ROX
0.79(0.70–0.87)
Original publication
Impact of an ROX index-guided intubation strategy on mortality in patients receiving high-flow nasal cannula: a target trial emulation. J Intensive Care. Published 14 August 2026. doi:10.
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