High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial

Andino, Ricardo; Vega, Gema; Pacheco, Sandra K; Arevalillo, Nuria; Leal, Ana; Fernández, Laura; Rodriguez, María Jesús

doi:10.1177/1753466620956459

Cited by 22 publications

(23 citation statements)

References 49 publications

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“…The comprehensive search yielded 5507 records (e-Fig 1 in Additional file 1 ), of which 27 studies were included in this NMA [ 9 , 35 – 60 ]. These 27 studies included two three-group studies that directly compared NPPV with HFNC use and COT.…”

Section: Resultsmentioning

confidence: 99%

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Association of noninvasive respiratory support with mortality and intubation rates in acute respiratory failure: a systematic review and network meta-analysis

et al. 2021

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Background Noninvasive respiratory support devices may reduce the tracheal intubation rate compared with conventional oxygen therapy (COT). To date, few studies have compared high-flow nasal cannula (HFNC) use with noninvasive positive-pressure ventilation (NPPV). We conducted a network meta-analysis to compare the effectiveness of three respiratory support devices in patients with acute respiratory failure. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥ 16 years with acute hypoxic respiratory failure and randomized-controlled trials that compared two different oxygenation devices (COT, NPPV, or HFNC) before tracheal intubation were included. A frequentist-based approach with a multivariate random-effects meta-analysis was used. The network meta-analysis was performed using the GRADE Working Group approach. The outcomes were short-term mortality and intubation rate. Results Among 5507 records, 27 studies (4618 patients) were included. The main cause of acute hypoxic respiratory failure was pneumonia. Compared with COT, NPPV and HFNC use tended to reduce mortality (relative risk, 0.88 and 0.93, respectively; 95% confidence intervals, 0.76–1.01 and 0.80–1.08, respectively; both low certainty) and lower the risk of endotracheal intubation (0.81 and 0.78; 0.72–0.91 and 0.68–0.89, respectively; both low certainty); however, short-term mortality or intubation rates did not differ (0.94 and 1.04, respectively; 0.78–1.15 and 0.88–1.22, respectively; both low certainty) between NPPV and HFNC use. Conclusion NPPV and HFNC use are associated with a decreased risk of endotracheal intubation; however, there are no significant differences in short-term mortality. Trial registration PROSPERO (registration number: CRD42020139105, 01/21/2020)

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Section: Resultsmentioning

confidence: 99%

“…Mortality (in-hospital) 2. Intubation AHRF (pneumonia [100%]) NPPV: 53 (18) COT: 56 (18) NPPV: 232 (35) COT: 231 (28) Andino 2020 [ 60 ] 46 HFNC COT 1. Mortality (in-hospital) 2.…”

Section: Resultsmentioning

confidence: 99%

Association of noninvasive respiratory support with mortality and intubation rates in acute respiratory failure: a systematic review and network meta-analysis

et al. 2021

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“…The participants, interventions, comparisons, outcomes, and cohort characteristics of the included trials are shown in Table 1 and Additional file 1 : Table S3. The mean age at randomisation ranged from 46 to 73 years, the mean P/F ratio was predominantly < 200 (16 trials [64.0%]) [ 7 , 8 , 32 , 34 , 35 , 38 , 40 , 41 , 44 , 45 , 47 , 49 – 53 ], and the mean partial pressure of arterial carbon dioxide (PaCO 2 ) was > 50 mmHg in one trial (4.0%) [ 41 ]. Nine trials (36.0%) included immunocompromised patients [ 8 , 34 , 36 – 38 , 43 – 45 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy of non-invasive and invasive respiratory management strategies in adult patients with acute hypoxaemic respiratory failure: a systematic review and network meta-analysis

et al. 2021

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Background Although non-invasive respiratory management strategies have been implemented to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk of treatment failure. In the previous meta-analyses, the effect of non-invasive ventilation was not evaluated according to ventilation modes in those patients. Furthermore, no meta-analyses comparing non-invasive respiratory management strategies with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomized controlled trials (RCTs) comparing two different respiratory management strategies (continuous positive airway pressure (CPAP), pressure support ventilation (PSV), HFNO, SOT, or IMV) were reviewed. Results We included 25 RCTs (3,302 participants: 27 comparisons). Using SOT as the reference, CPAP (risk ratio [RR] 0.55; 95% confidence interval [CI] 0.31–0.95; very low certainty) was associated significantly with a lower risk of mortality. Compared with SOT, PSV (RR 0.81; 95% CI 0.62–1.06; low certainty) and HFNO (RR 0.90; 95% CI 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst (surface under the cumulative ranking curve value: 93.2, 65.0, 44.1, 23.9, and 23.9, respectively). Conclusions When performing non-invasive ventilation among patients with de novo AHRF, it is important to avoid excessive tidal volume and lung injury. Although pressure support is needed for some of these patients, it should be applied with caution because this may lead to excessive tidal volume and lung injury. Trial registration protocols.io (Protocol integer ID 49375, April 23, 2021). 10.17504/protocols.io.buf7ntrn.

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“…The included trials evaluated ve different interventions, and these included 5 of 10 potential head-to-head comparisons for short-term mortality and four different interventions and 4 of 6 potential head-to-head comparisons for intubation. Speci cally, nine trials compared PSV with SOT [29][30][31][32][33][34][35][36][37], ve trials compared CPAP with , ve trials compared HFNO with SOT [7,[43][44][45][46], three trials compared PSV with IMV [47][48][49], and two trials compared PSV with HFNO [50,51] (Table 1 and Fig. 2).…”

Section: Presentation Of Network Structure and Summary Of Network Geometrymentioning

confidence: 99%

“…the participants, interventions, comparisons, outcomes, and cohort characteristics of the included trials. The mean age at randomisation ranged from 46 to 73 years, mean P/F ratio was predominantly < 200 (16 trials [64.0%])[6,7,30,32,33, 36, 38,39,42,43,45,[47][48][49][50][51], and mean partial pressure of arterial carbon dioxide (PaCO 2 ) was > 50 mmHg in one trial (4.0%)[39], and nine trials (36.0%) included immunocompromised patients[7, 32, 34- 36, 41-43, 46]. Community-acquired pneumonia was the most common cause of AHRF in 14 trials (56.0%)[6, 7, 29, 30, 32-34, 36-38, 40, 42, 45, 48].…”

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confidence: 99%

Efficacy of Non-Invasive and Invasive Respiratory Managements in Adult Patients with Acute Hypoxaemic Respiratory Failure: A Systematic Review and Network Meta-Analysis

Sakuraya

Okano

Masuyama

et al. 2021

Preprint

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Background: Although non-invasive respiratory managements are preformed to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk for treatment failure. Choosing the most effective primary respiratory management for adults with de novo AHRF is a complex problem. In the previous meta-analyses, the effect of non-invasive ventilation was not sufficiently evaluated according to ventilation modes in patients with AHRF. Furthermore, no meta-analyses comparing non-invasive respiratory managements with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomised controlled trials comparing two different respiratory managements (continuous positive airway pressure [CPAP], pressure support ventilation [PSV], HFNO, SOT, or IMV) were reviewed. A network meta-analysis was performed via a frequentist approach with a multivariate random-effects meta-analysis. The certainty of evidence was assessed based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group approach. The primary outcome was short-term mortality.Results: Using SOT as the reference, CPAP (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.31–0.95; very low certainty) was significantly associated with a lower risk of mortality. Compared with SOT, PSV (RR, 0.81; 95% CI, 0.62–1.06; low certainty) and HFNO (RR, 0.90; 95% CI, 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst.Conclusions: Our findings imply that CPAP may be the most effective strategy as the primary non-invasive respiratory management for AHRF to avoid unnecessary pressure support. Trial registration: protocols.io (Protocol integer ID 49375, April 23, 2021). dx.doi.org/10.17504/protocols.io.buf7ntrn.

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High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial

Cited by 22 publications

References 49 publications

Association of noninvasive respiratory support with mortality and intubation rates in acute respiratory failure: a systematic review and network meta-analysis

Association of noninvasive respiratory support with mortality and intubation rates in acute respiratory failure: a systematic review and network meta-analysis

Efficacy of non-invasive and invasive respiratory management strategies in adult patients with acute hypoxaemic respiratory failure: a systematic review and network meta-analysis

Efficacy of Non-Invasive and Invasive Respiratory Managements in Adult Patients with Acute Hypoxaemic Respiratory Failure: A Systematic Review and Network Meta-Analysis

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