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High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis

BACKGROUND: High-flow nasal cannula (HFNC) can be used as an initial support strategy for patients with acute respiratory failure (ARF) and after extubation. However, no clear evidence exists to support or oppose HFNC use in clinical practice. We summarized the effects of HFNC, compared to conventio...

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Autores principales: Xu, Zhiheng, Li, Yimin, Zhou, Jianmeng, Li, Xi, Huang, Yongbo, Liu, Xiaoqing, Burns, Karen E. A., Zhong, Nanshan, Zhang, Haibo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192218/
https://www.ncbi.nlm.nih.gov/pubmed/30326893
http://dx.doi.org/10.1186/s12931-018-0908-7
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author Xu, Zhiheng
Li, Yimin
Zhou, Jianmeng
Li, Xi
Huang, Yongbo
Liu, Xiaoqing
Burns, Karen E. A.
Zhong, Nanshan
Zhang, Haibo
author_facet Xu, Zhiheng
Li, Yimin
Zhou, Jianmeng
Li, Xi
Huang, Yongbo
Liu, Xiaoqing
Burns, Karen E. A.
Zhong, Nanshan
Zhang, Haibo
author_sort Xu, Zhiheng
collection PubMed
description BACKGROUND: High-flow nasal cannula (HFNC) can be used as an initial support strategy for patients with acute respiratory failure (ARF) and after extubation. However, no clear evidence exists to support or oppose HFNC use in clinical practice. We summarized the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on important outcomes including treatment failure and intubation/reintubation rates in adult patients with ARF and after extubation. METHODS: We searched 4 electronic databases (Pubmed, EMBASE, Scopus, and Web of Science) to identify randomized controlled trials (RCTs) comparing the effects of HFNC with either COT or NIV on rates of 1) treatment failure and 2) intubation/reintubation in adult critically ill patients. RESULTS: We identified 18 RCTs (n = 4251 patients) in pooled analyses. As a primary mode of support, HFNC treatment reduced the risk of treatment failure [Odds Ratio (OR) 0.65; 95% confidence interval (CI) 0.43–0.98; p = 0.04; I(2) = 32%] but had no effect on preventing intubation (OR, 0.74; 95%CI 0.45–1.21; p = 0.23; I(2) = 0%) compared to COT. When used after extubation, HFNC (vs. COT) treatment significantly decreased reintubation rate (OR 0.46; 95%CI 0.33–0.63; p < 0.00001; I(2) = 30%) and extubation failure (OR 0.43; 95%CI 0.25–0.73; p = 0.002; I(2) = 66%). Compared to NIV, HFNC significantly reduced intubation rate (OR 0.57; 95%CI 0.36–0.92; p = 0.02; I(2) = 0%) when used as initial support, but did no favorably impact clinical outcomes post extubation in few trials. CONCLUSIONS: HFNC was superior to COT in reducing treatment failure when used as a primary support strategy and in reducing rates of extubation failure and reintubation when used after extubation. In few trials, HFNC reduced intubation rate compared to NIV when used as initial support but demonstrated no beneficial effects after extubation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12931-018-0908-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-61922182018-10-22 High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis Xu, Zhiheng Li, Yimin Zhou, Jianmeng Li, Xi Huang, Yongbo Liu, Xiaoqing Burns, Karen E. A. Zhong, Nanshan Zhang, Haibo Respir Res Review BACKGROUND: High-flow nasal cannula (HFNC) can be used as an initial support strategy for patients with acute respiratory failure (ARF) and after extubation. However, no clear evidence exists to support or oppose HFNC use in clinical practice. We summarized the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on important outcomes including treatment failure and intubation/reintubation rates in adult patients with ARF and after extubation. METHODS: We searched 4 electronic databases (Pubmed, EMBASE, Scopus, and Web of Science) to identify randomized controlled trials (RCTs) comparing the effects of HFNC with either COT or NIV on rates of 1) treatment failure and 2) intubation/reintubation in adult critically ill patients. RESULTS: We identified 18 RCTs (n = 4251 patients) in pooled analyses. As a primary mode of support, HFNC treatment reduced the risk of treatment failure [Odds Ratio (OR) 0.65; 95% confidence interval (CI) 0.43–0.98; p = 0.04; I(2) = 32%] but had no effect on preventing intubation (OR, 0.74; 95%CI 0.45–1.21; p = 0.23; I(2) = 0%) compared to COT. When used after extubation, HFNC (vs. COT) treatment significantly decreased reintubation rate (OR 0.46; 95%CI 0.33–0.63; p < 0.00001; I(2) = 30%) and extubation failure (OR 0.43; 95%CI 0.25–0.73; p = 0.002; I(2) = 66%). Compared to NIV, HFNC significantly reduced intubation rate (OR 0.57; 95%CI 0.36–0.92; p = 0.02; I(2) = 0%) when used as initial support, but did no favorably impact clinical outcomes post extubation in few trials. CONCLUSIONS: HFNC was superior to COT in reducing treatment failure when used as a primary support strategy and in reducing rates of extubation failure and reintubation when used after extubation. In few trials, HFNC reduced intubation rate compared to NIV when used as initial support but demonstrated no beneficial effects after extubation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12931-018-0908-7) contains supplementary material, which is available to authorized users. BioMed Central 2018-10-16 2018 /pmc/articles/PMC6192218/ /pubmed/30326893 http://dx.doi.org/10.1186/s12931-018-0908-7 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Xu, Zhiheng
Li, Yimin
Zhou, Jianmeng
Li, Xi
Huang, Yongbo
Liu, Xiaoqing
Burns, Karen E. A.
Zhong, Nanshan
Zhang, Haibo
High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
title High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
title_full High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
title_fullStr High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
title_full_unstemmed High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
title_short High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
title_sort high-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192218/
https://www.ncbi.nlm.nih.gov/pubmed/30326893
http://dx.doi.org/10.1186/s12931-018-0908-7
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