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Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis.
Chest. 2017 Apr; 151(4):764-775.Chest

Abstract

BACKGROUND

The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).

METHODS

The PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as the Information Sciences Institute Web of Science, were searched for all controlled studies that compared HFNC with NIPPV and COT in adult patients with ARF. The primary outcome was the rate of endotracheal intubation; the secondary outcomes were ICU mortality and length of ICU stay.

RESULTS

Eighteen trials with a total of 3,881 patients were pooled in our final studies. Except for ICU mortality (I2 = 67%, χ2 = 12.21, P = .02) and rate of endotracheal intubation (I2 = 63%, χ2 = 13.51, P = .02) between HFNC and NIPPV, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of endotracheal intubation (z = 2.55, P = .01) while no significant difference was found in the comparison with NIPPV (z = 1.40, P = .16). As for ICU mortality and length of ICU stay, HFNC did not exhibit any advantage over either COT or NIPPV.

CONCLUSIONS

In patients with ARF, HFNC is a more reliable alternative than NIPPV to reduce the rate of endotracheal intubation than COT.

Authors+Show Affiliations

Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China. Electronic address: liangbinmiao@163.com.Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28089816

Citation

Ni, Yue-Nan, et al. "Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: a Systematic Review and Meta-analysis." Chest, vol. 151, no. 4, 2017, pp. 764-775.
Ni YN, Luo J, Yu H, et al. Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis. Chest. 2017;151(4):764-775.
Ni, Y. N., Luo, J., Yu, H., Liu, D., Ni, Z., Cheng, J., Liang, B. M., & Liang, Z. A. (2017). Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis. Chest, 151(4), 764-775. https://doi.org/10.1016/j.chest.2017.01.004
Ni YN, et al. Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: a Systematic Review and Meta-analysis. Chest. 2017;151(4):764-775. PubMed PMID: 28089816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis. AU - Ni,Yue-Nan, AU - Luo,Jian, AU - Yu,He, AU - Liu,Dan, AU - Ni,Zhong, AU - Cheng,Jiangli, AU - Liang,Bin-Miao, AU - Liang,Zong-An, Y1 - 2017/01/13/ PY - 2016/10/21/received PY - 2016/12/16/revised PY - 2017/01/02/accepted PY - 2017/1/17/pubmed PY - 2017/5/16/medline PY - 2017/1/17/entrez KW - acute respiratory failure KW - endotracheal intubation KW - high-flow nasal cannula KW - meta-analysis KW - prognosis SP - 764 EP - 775 JF - Chest JO - Chest VL - 151 IS - 4 N2 - BACKGROUND: The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT). METHODS: The PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as the Information Sciences Institute Web of Science, were searched for all controlled studies that compared HFNC with NIPPV and COT in adult patients with ARF. The primary outcome was the rate of endotracheal intubation; the secondary outcomes were ICU mortality and length of ICU stay. RESULTS: Eighteen trials with a total of 3,881 patients were pooled in our final studies. Except for ICU mortality (I2 = 67%, χ2 = 12.21, P = .02) and rate of endotracheal intubation (I2 = 63%, χ2 = 13.51, P = .02) between HFNC and NIPPV, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of endotracheal intubation (z = 2.55, P = .01) while no significant difference was found in the comparison with NIPPV (z = 1.40, P = .16). As for ICU mortality and length of ICU stay, HFNC did not exhibit any advantage over either COT or NIPPV. CONCLUSIONS: In patients with ARF, HFNC is a more reliable alternative than NIPPV to reduce the rate of endotracheal intubation than COT. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/28089816/Can_High_flow_Nasal_Cannula_Reduce_the_Rate_of_Endotracheal_Intubation_in_Adult_Patients_With_Acute_Respiratory_Failure_Compared_With_Conventional_Oxygen_Therapy_and_Noninvasive_Positive_Pressure_Ventilation:_A_Systematic_Review_and_Meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(17)30011-9 DB - PRIME DP - Unbound Medicine ER -