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High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Int J Chron Obstruct Pulmon Dis. 2022; 17:1987-1999.IJ

Abstract

Objective

To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation.

Research Methods

This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay.

Results

Eight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (-0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different.

Conclusion

According to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV.

Links

Authors+Show Affiliations

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People's Republic of China.

MeSH

Airway ExtubationCannulaHumansHypercapniaNoninvasive VentilationOxygenOxygen Inhalation TherapyPulmonary Disease, Chronic ObstructiveRandomized Controlled Trials as TopicRespiratory Insufficiency

Pub Type(s)

Journal Article

Meta-Analysis

Review

Systematic Review

Language

eng

PubMed ID

36065316

Citation

Feng, Zhouzhou, et al. "High-Flow Nasal Cannula Oxygen Therapy Versus Non-Invasive Ventilation for AECOPD Patients After Extubation: a Systematic Review and Meta-Analysis of Randomized Controlled Trials." International Journal of Chronic Obstructive Pulmonary Disease, vol. 17, 2022, pp. 1987-1999.

Feng Z, Zhang L, Yu H, et al. High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Chron Obstruct Pulmon Dis. 2022;17:1987-1999.

Feng, Z., Zhang, L., Yu, H., Su, X., Shuai, T., Zhu, L., Chen, ., & Liu, J. (2022). High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International Journal of Chronic Obstructive Pulmonary Disease, 17, 1987-1999. https://doi.org/10.2147/COPD.S375107

Feng Z, et al. High-Flow Nasal Cannula Oxygen Therapy Versus Non-Invasive Ventilation for AECOPD Patients After Extubation: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Chron Obstruct Pulmon Dis. 2022;17:1987-1999. PubMed PMID: 36065316.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. AU - Feng,Zhouzhou, AU - Zhang,Lu, AU - Yu,Haichuan, AU - Su,Xiaojie, AU - Shuai,Tiankui, AU - Zhu,Lei, AU - Chen,De, AU - Liu,Jian, Y1 - 2022/08/30/ PY - 2022/05/26/received PY - 2022/08/22/accepted PY - 2022/9/6/entrez PY - 2022/9/7/pubmed PY - 2022/9/9/medline KW - acute exacerbation of chronic obstructive pulmonary disease KW - meta-analysis KW - nasal high-flow oxygen therapy KW - non-invasive ventilation SP - 1987 EP - 1999 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 17 N2 - Objective: To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation. Research Methods: This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay. Results: Eight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (-0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different. Conclusion: According to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/36065316/High_Flow_Nasal_Cannula_Oxygen_Therapy_versus_Non_Invasive_Ventilation_for_AECOPD_Patients_After_Extubation:_A_Systematic_Review_and_Meta_Analysis_of_Randomized_Controlled_Trials_ DB - PRIME DP - Unbound Medicine ER -