High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis

Zhu, Youfeng; Yin, Hui; Zhang, Rui; Ye, Xiaoling; Wei, Jianrui

doi:10.1186/s13054-019-2465-y

Cited by 67 publications

(72 citation statements)

References 39 publications

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“…HFNC is a novel oxygen therapy developed in recent years, in which oxygen at a certain concentration mixed with highflow gas is directly delivered to patients through a nonsealed nasal cannula [6,7]. is oxygen therapy has been assessed by many studies and can be applied to patients with acute hypoxemic respiratory failure, status-post surgery, and respiratory failure without tracheal intubation, immunosuppression, and cardiac insufficiency, thus effectively improving oxygenation [8][9][10][11][12][13][14][15]. However, few studies have confirmed the efficacy of HFNC in treating bronchial asthma, focusing mainly on pediatric and neonatal patients [16,17].…”

Section: Introductionmentioning

confidence: 99%

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

Geng

Batu

You

et al. 2020

Canadian Respiratory Journal

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Severe bronchial asthma complicated with respiratory failure, a common critical illness in respiratory medicine, may be lifethreatening. High-flow nasal cannula (HFNC) is a novel oxygen therapy technique developed in recent years. HFNC was applied in this study for treating adult patients with severe bronchial asthma complicated with respiratory failure. Its efficacy was analyzed comparatively to conventional oxygen therapy (COT). HFNC and COT were randomly performed based on conventional treatment. e HFNC group was similar to COT-treated patients in terms of response rate, with no significant difference in efficacy between the two groups. In patients with bronchial asthma, effectively increased PO 2 and reduced PCO 2 were observed after treatment in both groups. However, HFNC was more efficient than COT in elevating PO 2 in patients with severe bronchial asthma complicated with respiratory failure, while no statistically significant difference in PCO 2 reduction was found between the two groups. Heart rate (HR) and respiratory rate (RR) between the two groups on admission (0 h) and at 2, 8, 24, and 48 h after admission were compared. Both indicators significantly decreased with time. No significant differences in HR and RR were found between the groups at 0, 2, and 8 h after admission. However, these indicators were significantly lower in the HFNC group compared with the COT group at 24 and 48 h after admission. HFNC could significantly elevate PO 2 and reduce HR and RR. us, it is a promising option for patients with severe bronchial asthma complicated with respiratory failure.

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Section: Introductionmentioning

confidence: 99%

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

Geng

Batu

You

et al. 2020

Canadian Respiratory Journal

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ HFNC was initially utilized as an alternative breathing support for premature infants to maintain positive airway pressure [37][38][39] ; however, there is a propensity to use HFNC therapy in adults with respiratory distress 8,40,41 . In the latest meta-analysis conducted by Zhu and colleague 40 , HFNC had significantly effect on reducing post-extubation respiratory failure rate, respiratory rates, and increasing PaO 2 , comparing with conventional oxygen therapy in patients after planned extubation. In most of studies [42][43][44] , HFNC was compared with standard of care to demonstrate that this approach was able to improve oxygenation.…”

Section: Discussionmentioning

confidence: 99%

High-flow nasal cannula therapy as apneic oxygenation during endotracheal intubation in critically ill patients in the intensive care unit: a systematic review and meta-analysis

Jhou

Chen

Lin

et al. 2020

Sci Rep

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We conducted a systematic review and meta-analysis to assess the clinical efficacy of high-flow nasal cannula (HFNC) therapy as apneic oxygenation in critically ill patients who require endotracheal intubation in the intensive care unit (ICU). This systematic review and meta-analysis included six randomized controlled trials and a prospective study identified in PubMed, Embase, Cochrane Library, and the Web of Science until August 18, 2019. In this meta-analysis including 956 participants, HFNC was noninferior to standard of care during endotracheal intubation regarding incidence of severe hypoxemia, mean lowest oxygen saturation, and in-hospital mortality. HFNC significantly shortened the ICU stay by a mean of 1.8 days. In linear meta-regression interaction analysis, the risk ratio of severe hypoxemia decreased with increasing baseline partial oxygen pressure (PaO 2 ) to fraction of inspired oxygen (FiO 2 ) ratio. In subgroup analysis, HFNC significantly reduced the incidence of severe hypoxemia during endotracheal intubation in patients with mild hypoxemia (PaO 2 /fio 2 > 200 mmHg; risk difference, −0.06; 95% confidence interval, −0.12 to −0.01; number needed to treat = 16.7). In conclusion, HFNC was noninferior to standard of care for oxygen delivery during endotracheal intubation and was associated with a significantly shorter ICU stay. The beneficial effect of HFNC in reducing the incidence of severe hypoxemia was observed in patients with mild hypoxemia.Each year in the United States, approximately 1.5 million patients are estimated to receive endotracheal intubation and the rate of intubation is increasing in the hospital 1 . Hypoxemia, a frequently reported complication of intubation, is considered a predisposing factor for cardiac arrest and death 2-5 . Therefore, oxygenation during endotracheal intubation plays an important role in prolonging the maintenance of acceptable oxygen saturation levels.In 1959, Frumin et al. 6 were the first to develop apneic oxygenation, which delivered supplemental oxygen via nasal cannulation during surgery and anesthesia to allow for sustained levels of sufficient oxygen in alveoli and blood. A recent clinical trial convincingly demonstrated that apneic oxygenation during endotracheal intubation

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confidence: 99%

“…Therefore, the figure of trial sequential analysis may better be not drawn based on a rough estimated RRR. Thank you very much for giving us the opportunity to respond to the valuable comments pointed out by Meng-Si Luo and colleagues with regard to our study [1].First, randomized controlled trials (RCTs) and crossover studies were not pooled together for primary outcome and main secondary outcomes in our article, only pooled together for secondary outcomes of respiratory rate, PaO 2 , and comfort score. According to the guidelines described in the Cochrane Handbook for Systematic Reviews of Interventions, quasi-RCTs and cross-over studies can be included for analysis, particularly when few RCTs addressing the topic of the review are identified [3].…”

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High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation

Luo

Huang

2019

Crit Care

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We read with great interest the recent systematic review and meta-analysis of high-flow nasal cannula (HFNC) oxygen therapy versus conventional oxygen therapy (COT) in patients after planned extubation [1]. We greatly appreciate Zhu Y and colleagues' efforts, but some important issues may better be discussed.First, randomized controlled trials (RCTs) and non-RCTs may be inappropriately combined together in the meta-analysis, which goes against the principle of pooling studies with the similar design [2, 3]. Thus, results from RCTs and non-RCTs may better be separately pooled ( Fig. 1a, b). Our Fig. 1 a and b show that the pooled results of RCTs and non-RCTs were not entirely consistent and subgroup analyses significantly decreased the heterogeneity, which suggested that the heterogeneity may originate from pooling studies with the different design. While we found that the pooled results of RCTs were even more biased in favor of HFNC than non-RCTs.Second, using the standardized mean difference as the summary statistic for the meta-analyses of PaO 2 and respiratory rates may be improper. The standardized mean difference is utilized as the summary statistic in the meta-analysis when the trials all assess the same outcome, but measure it in various ways [3]. Moreover, the standardized mean difference is unitless, which only shows the difference in a relatively measurement scale rather than a real difference in variability [3]. Therefore, the mean difference may better be used as the summary statistic to pool data (Fig. 1a, b).Third, trial sequential analysis for comparison of postextubation respiratory failure between two groups may better be drawn based on the accurate relative risk reduction (RRR) of 37.17% ( 118 534 − 74 533 118 534). Then, Fig. 1c is drawn to show that the line of cumulative Z-curve neither crossed the line of the trial sequential monitoring boundary for benefit nor the required information size boundary, which established inconclusive evidence [4]. But in the authors' Figure S7, the line of cumulative Z-curve obviously crossed the line of the trial sequential monitoring boundary for benefit, which may mislead the interpretation because of the inaccurate trial sequential analysis. Therefore, the figure of trial sequential analysis may better be not drawn based on a rough estimated RRR. Thank you very much for giving us the opportunity to respond to the valuable comments pointed out by Meng-Si Luo and colleagues with regard to our study [1].First, randomized controlled trials (RCTs) and crossover studies were not pooled together for primary outcome and main secondary outcomes in our article, only pooled together for secondary outcomes of respiratory rate, PaO 2 , and comfort score. According to the guidelines described in the Cochrane Handbook for Systematic Reviews of Interventions, quasi-RCTs and cross-over studies can be included for analysis, particularly when few RCTs addressing the topic of the review are identified [3]. Furthermore, for resolving the potential bias

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High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis

Cited by 67 publications

References 39 publications

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

High-flow nasal cannula therapy as apneic oxygenation during endotracheal intubation in critically ill patients in the intensive care unit: a systematic review and meta-analysis

High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation

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