Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Abstract

BACKGROUND: De novo hypoxemic respiratory failure is defined as significant hypoxemia in the absence of chronic lung disease such as COPD, and excluding respiratory failure occurring in the immediate postoperative or postextubation period. We aimed to evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in patients with de novo hypoxemic respiratory failure. METHODS: We performed electronic database searches of PubMed, Cochrane Library, and Embase from inception to December 2018 to include randomized controlled trials that compared various oxygenation strategies in cases of de novo hypoxemic respiratory failure occurring in adult subjects without a preexisting chronic lung disease and excluding respiratory failure in the immediate postoperative or postextubation periods. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrI). RESULTS: 16 studies were included, involving 2,180 subjects with a mean age of 61 ؎ 17 y (66% were male; 46% of the included subjects were treated with conventional oxygen, 27.8% were treated with NIV, and 25.8% were treated with HFNC). Compared to conventional oxygen, NIV was associated with reduced intubation rates (OR 0.42, 95% CrI 0.26-0.62) but no significant reduction in short-term (OR 0.73, 95% CrI 0.47-1.02) or long-term mortality (OR 0.60, 95% CrI 0.29-1.06). There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes. In a sensitivity analysis, the results remained consistent after exclusion of studies that included subjects with respiratory failure secondary to cardiogenic pulmonary edema. CONCLUSION: Among subjects with hypoxemic respiratory failure, NIV was associated with a significant reduction in intubation rates but not short-or long-term mortality when compared to conventional oxygen therapy. There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes.

High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission

“…Full-text review of 38 potentially eligible studies identified 20 eligible studies. Of these, 17 were systematic reviews (SRs) 15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and three were RCTs [41][42][43] (Fig. 1).…”

High-Flow Nasal Cannula vs. Continuous Positive Airway Pressure Therapy for the Treatment of Children <2 Years With Mild to Moderate Respiratory Failure Due to Pneumonia

“…An open RCT of bubble CPAP for children with severe pneumonia and hypoxemia in Bangladesh also showed that there was no difference in treatment failure between patients in the bubble CPAP group and the HFNC group (24). A review of initial non-invasive oxygenation strategies in patients with de novo acute hypoxemic respiratory failure included 16 studies, and it found that non-invasive ventilation (NIV) was associated with a significant reduction in intubation rates compared with conventional oxygen therapy, but there was no significant difference in the efficacy with HFNC (25). These findings are consistent with our research results, but the results are different from those of the meta-analysis of HFNC vs. CPAP in children with respiratory distress (18).…”

Comparison of high‐flow oxygenation with noninvasive ventilation in COPD exacerbation: A crossover clinical trial

“…NIV has played a crucial role in COPD‐exacerbation management compare to standard O 2 therapy. The rate of tracheal intubation, mortality rate, and ICU stay significantly improved by employing NIV 13,17 . However, there are some limitations corresponded to NIV that should be addressed.…”