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Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials.
CMAJ. 2017 Feb 21; 189(7):E260-E267.CMAJ

Abstract

BACKGROUND

Conflicting recommendations exist on whether high-flow nasal cannula (HFNC) oxygen therapy should be administered to adult patients in critical care with acute hypoxemic respiratory failure. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate its effect on intubation rates.

METHODS

We searched electronic databases from inception to April 2016. We included RCTs that compared HFNC oxygen therapy with usual care (conventional oxygen therapy or noninvasive ventilation) in adults with acute hypoxemic respiratory failure. Because of the different methodologies and variation in clinical outcomes, we conducted 2 subgroup analyses according to oxygen therapy used and disease severity. We pooled data using random-effects models. The primary outcome was the proportion of patients who required endotracheal intubation.

RESULTS

We included 6 RCTs (n = 1892). Compared with conventional oxygen therapy, HFNC oxygen therapy was associated with a lower intubation rate (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.38 to 0.94; I2 = 49%). We found no significant difference in the rate between HFNC oxygen therapy and noninvasive ventilation (RR 0.86, 95% CI 0.68 to 1.09; I2 = 2%). In the subgroup analysis by disease severity, no significant differences were found in the intubation rate between HFNC oxygen therapy and either conventional oxygen therapy or noninvasive ventilation (interaction p = 0.3 and 0.4, respectively).

INTERPRETATION

The intubation rate with HFNC oxygen therapy was lower than the rate with conventional oxygen therapy and similar to the rate with noninvasive ventilation among patients with acute hypoxemic respiratory failure. Larger, high-quality RCTs are needed to confirm these findings.

Authors+Show Affiliations

Department of Anesthesiology and Translational Neuroscience Center (Ou, Liu, Gong, Zhao), Laboratory of Anesthesia and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan; Department of Anesthesiology (Hua), Subei People's Hospital of Jiangsu Province, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.Department of Anesthesiology and Translational Neuroscience Center (Ou, Liu, Gong, Zhao), Laboratory of Anesthesia and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan; Department of Anesthesiology (Hua), Subei People's Hospital of Jiangsu Province, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.Department of Anesthesiology and Translational Neuroscience Center (Ou, Liu, Gong, Zhao), Laboratory of Anesthesia and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan; Department of Anesthesiology (Hua), Subei People's Hospital of Jiangsu Province, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China 2014324020096@stu.scu.edu.cn.Department of Anesthesiology and Translational Neuroscience Center (Ou, Liu, Gong, Zhao), Laboratory of Anesthesia and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan; Department of Anesthesiology (Hua), Subei People's Hospital of Jiangsu Province, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.Department of Anesthesiology and Translational Neuroscience Center (Ou, Liu, Gong, Zhao), Laboratory of Anesthesia and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan; Department of Anesthesiology (Hua), Subei People's Hospital of Jiangsu Province, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28246239

Citation

Ou, Xiaofeng, et al. "Effect of High-flow Nasal Cannula Oxygen Therapy in Adults With Acute Hypoxemic Respiratory Failure: a Meta-analysis of Randomized Controlled Trials." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 189, no. 7, 2017, pp. E260-E267.
Ou X, Hua Y, Liu J, et al. Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials. CMAJ. 2017;189(7):E260-E267.
Ou, X., Hua, Y., Liu, J., Gong, C., & Zhao, W. (2017). Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 189(7), E260-E267. https://doi.org/10.1503/cmaj.160570
Ou X, et al. Effect of High-flow Nasal Cannula Oxygen Therapy in Adults With Acute Hypoxemic Respiratory Failure: a Meta-analysis of Randomized Controlled Trials. CMAJ. 2017 Feb 21;189(7):E260-E267. PubMed PMID: 28246239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials. AU - Ou,Xiaofeng, AU - Hua,Yusi, AU - Liu,Jin, AU - Gong,Cansheng, AU - Zhao,Wenling, PY - 2016/08/28/accepted PY - 2017/3/2/entrez PY - 2017/3/2/pubmed PY - 2017/4/18/medline SP - E260 EP - E267 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 189 IS - 7 N2 - BACKGROUND: Conflicting recommendations exist on whether high-flow nasal cannula (HFNC) oxygen therapy should be administered to adult patients in critical care with acute hypoxemic respiratory failure. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate its effect on intubation rates. METHODS: We searched electronic databases from inception to April 2016. We included RCTs that compared HFNC oxygen therapy with usual care (conventional oxygen therapy or noninvasive ventilation) in adults with acute hypoxemic respiratory failure. Because of the different methodologies and variation in clinical outcomes, we conducted 2 subgroup analyses according to oxygen therapy used and disease severity. We pooled data using random-effects models. The primary outcome was the proportion of patients who required endotracheal intubation. RESULTS: We included 6 RCTs (n = 1892). Compared with conventional oxygen therapy, HFNC oxygen therapy was associated with a lower intubation rate (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.38 to 0.94; I2 = 49%). We found no significant difference in the rate between HFNC oxygen therapy and noninvasive ventilation (RR 0.86, 95% CI 0.68 to 1.09; I2 = 2%). In the subgroup analysis by disease severity, no significant differences were found in the intubation rate between HFNC oxygen therapy and either conventional oxygen therapy or noninvasive ventilation (interaction p = 0.3 and 0.4, respectively). INTERPRETATION: The intubation rate with HFNC oxygen therapy was lower than the rate with conventional oxygen therapy and similar to the rate with noninvasive ventilation among patients with acute hypoxemic respiratory failure. Larger, high-quality RCTs are needed to confirm these findings. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/28246239/full_citation L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=28246239 DB - PRIME DP - Unbound Medicine ER -