Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Yu, Yuetian; Qian, Xiaozhe; Liu, Chunyan; Zhu, Cheng

doi:10.1155/2017/7894631

Cited by 65 publications

(93 citation statements)

References 24 publications

(26 reference statements)

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“…Four of the studies included only thoracic surgical patients,37424345 with two studying patients undergoing thoracoabdominal vascular repairs via a midline laparotomy,3841 and two RCTs including elective upper abdominal surgical patients 3940. Both trials of high flow nasal cannulas included patients with an intermediate to high predictive risk of PPCs (assessed as an ARISCAT score ≥26846), with one study recruiting a mixed population of emergency and elective abdominal and thoracic procedures,28 and one study recruiting only thoracic thoracoscopic lobectomy patients 45…”

Section: Resultsmentioning

confidence: 99%

“…Duration of ventilatory support ranged from two 120 minute cycles of helmet continuous positive airway pressure on the first postoperative day only to bi-level positive airway pressure provided preoperatively for seven days and then daily during the postoperative inpatient stay 43. Five of the nine trials involved provision of the intervention for less than 24 hours,2836373841 and one trial for three days,40 whereas the remainder continued to provide ventilator support while patients were in hospital 39424345. Full details of included trials and individual meta-analysis of prophylactic non-invasive ventilation are provided in appendix 2, section 6.…”

Section: Resultsmentioning

confidence: 99%

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Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

129

120

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OBJECTIVE To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGNSystematic review and meta-analysis of randomised controlled trials. DATA SOURCESMedline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIARandomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESISReviewers independently identified studies, extracted data, and assessed the quality of evidence. Metaanalyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONSPredominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGIS...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

129

120

View full text Add to dashboard Cite

show abstract

“…The RCTs included were all assessed to be at low risk of bias with respect to randomization and allocation concealment except for 3 trials [ 25 , 31 , 32 ] for which selection bias was deemed unclear. The same 3 trials also were assessed to be at unclear risk of bias with regard to blinded outcome assessment, completeness of outcomes data, selective outcomes reporting, and other potential sources of bias [ 25 , 31 , 32 ]. All trials were deemed to be at high risk of performance bias as blinding of patients, physicians, and research personnel to treatment allocation was not feasible (Fig.…”

Section: Resultsmentioning

confidence: 99%

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

Zhou

et al. 2018

Respir Res

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BackgroundHigh-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.MethodsWe 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.ResultsWe 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; I2 = 32%] but had no effect on preventing intubation (OR, 0.74; 95%CI 0.45–1.21; p = 0.23; I2 = 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; I2 = 30%) and extubation failure (OR 0.43; 95%CI 0.25–0.73; p = 0.002; I2 = 66%). Compared to NIV, HFNC significantly reduced intubation rate (OR 0.57; 95%CI 0.36–0.92; p = 0.02; I2 = 0%) when used as initial support, but did no favorably impact clinical outcomes post extubation in few trials.ConclusionsHFNC 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 materialThe online version of this article (10.1186/s12931-018-0908-7) contains supplementary material, which is available to authorized users.

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“…A total of 3 studies reported the rate of escalation of respiratory support. [ 32 , 34 , 35 ] The escalation of respiratory support in COT group is regarded as use of HFNC, NIV, or reintubation. The escalation of respiratory support in HFNC group is regarded as use of NIV or reintubation.…”

Section: Resultsmentioning

confidence: 99%

Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen therapy on adult postcardiothoracic operation

Cao²,

Zhang³

et al. 2018

Medicine

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Introduction:The effect of high-flow nasal cannula (HFNC) on adult post cardiothoracic operation remains controversial. We conducted a meta-analysis of randomized controlled trials to evaluate the effect of HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery.Methods:A search was conducted in Embase, MEDLINE, Ovid, and Cochrane databases until December, 2017 for all the controlled study to compare HFNC with COT in adult postcardiothoracic surgery. Two authors extracted data and assessed the quality of each study independently. The meta-analysis was performed by using RevMan 5.3. The primary outcome was the rate of escalation of respiratory support rate and pulmonary complications; secondary outcome included the length of intensive care unit (ICU) stay and length of hospital stay and the rate of intubation.Results:Four studies that involved 649 patients were included in the analysis. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC were associated with a significant reduction in the escalation of respiratory support (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.29−0.66, P < .001) and pulmonary complications (OR = 0.28, 95% CI = 0.13−0.6, P = .001). There were no significant differences in the reintubation rate (OR = 0.33, 95% CI = 0.02−5.39, P = .43), length of ICU stay (weighted mean difference = 0.11; 95% CI = −0.44 −0.26, P = .14) or length of hospital stay (weighted mean difference = −0.15, 95% CI = −0.46 −0.17, P = .36) between the 2 groups. No severe complications were reported in either group.Conclusion:The HFNC could reduce respiratory support and pulmonary complications, and it could be safely administered for adult postcardiothoracic surgery. Further large-scale, randomized, and controlled trials are needed to update this finding.

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Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Cited by 65 publications

References 24 publications

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

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

Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen therapy on adult postcardiothoracic operation

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