Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial

Abstract

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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

“…1) (Supplementary Information 5). Table 1 summarized the basic characteristics of the seven studies, including six RCTs and one prospective non-randomized study, which were published between 2015 and 2019 [11][12][13][32][33][34][35] . There were a total of 956 participants, including 501 patients receiving HFNC during the apneic period and 455 receiving standard of care oxygen therapy.…”

“…The incidence of severe hypoxemia during endotracheal intubation was examined in all seven studies [11][12][13][32][33][34][35] . Our analysis revealed that the incidence of severe hypoxemia did not differ between the HFNC and the standard of care groups during endotracheal intubation with the random-effects model; however, there was moderate heterogeneity among the studies (RD = −0.05, 95% CI −0.11 to 0.01; I 2 = 38%, P = 0.14; Fig.…”

“…In the meta-analysis of all seven studies that evaluated lowest oxygen saturation (501 and 455 patients in the HFNC and the standard of care groups, respectively) [11][12][13][32][33][34][35] , the mean lowest oxygen saturation during endotracheal intubation did not differ significantly between the HFNC and the standard of care groups with the random-effects model and exhibited high heterogeneity among the studies (MD = 2.04, 95% CI = −0.17 to 4.26; I 2 = 68%, P < 0.01; Fig. 2B).…”

“…In the meta-analysis of the six studies examining in-hospital mortality (481 and 435 patients in the HFNC and the standard of care groups, respectively) [11][12][13]32,33,35 , there was no significant difference in the in-hospital mortality between the HFNC and the standard of care groups with the random-effects model (RD = −0.04, 95% CI = −0.10 to 0.01; I 2 = 0%, P = 0.81; Fig. 2D).…”

“…Similarly, Vourc'h et al 12 found that the lowest oxygen saturation level was higher with HFNC. Despite these encouraging benefits of HFNC, the latest randomized control trial (RCT) 13 by Frat et al reported that HFNC did not significantly alter the risk of severe hypoxemia during intubation.…”