P235 High flow nasal therapy for acute type 2 respiratory failure: a systematic review and meta-analysis

Alnajada, Asem; Blackwood, Bronagh; Mobrad, AM; Akhtar, Adeel; Shyamsundar,

doi:10.1136/thorax-2020-btsabstracts.380

Cited by 2 publications

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“…With the assistance of a professional librarian, we developed a systematic search strategy using appropriate keywords and MeSH terms and these are detailed in the data availability section (see Extended data ). 30 The systematic review software management system Covidence was used to store citations, remove duplication and aid screening.…”

Section: Methodsmentioning

confidence: 99%

High flow nasal oxygen for acute type two respiratory failure: a systematic review

et al. 2021

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Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 – 7.7 vs NIV median 7.6, IQR 6.3 – 9.3) and no significant difference at 24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.

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Section: Methodsmentioning

confidence: 99%

High flow nasal oxygen for acute type two respiratory failure: a systematic review

et al. 2021

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“…We conducted this systematic review according to the PRISMA guidelines (see Reporting guidelines). 26,27 Eligibility criteria Randomized controlled trials, uncontrolled trials and cohort studies were included if they compared the use of HFNT with a flow rate >20 L/minutes versus LFO or NIV. We included studies of adult (≥18 years old) patients with AT2RF (>6 kPa or >45 mmHg) managed as inpatients in an acute care setting (emergency department, respiratory ward or critical care units).…”

Section: Methodsmentioning

confidence: 99%

“…With the assistance of a professional librarian, we developed a systematic search strategy using appropriate keywords and MeSH terms and these are detailed in the data availability section (see Extended data). 27 The systematic review software management system Covidence was used to store citations, remove duplication and aid screening.…”

Section: Search Strategymentioning

confidence: 99%

“…https://doi.org/10.17034/4080c4eb-38f0-4c02-91ee-37129ceb65a6. 27 This project contains the following extended data:…”

Section: Data Availabilitymentioning

confidence: 99%

“…https://doi.org/10.17034/4080c4eb-38f0-4c02-91ee-37129ceb65a6. 27 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).…”

Section: Data Availabilitymentioning

confidence: 99%

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High flow nasal oxygen for acute type two respiratory failure: a systematic review

et al. 2021

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P235 High flow nasal therapy for acute type 2 respiratory failure: a systematic review and meta-analysis

Cited by 2 publications

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High flow nasal oxygen for acute type two respiratory failure: a systematic review

High flow nasal oxygen for acute type two respiratory failure: a systematic review

High flow nasal oxygen for acute type two respiratory failure: a systematic review

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