Rafael Ladeira Rosa Bocchile1, Denise Carnieli Cazati1, Karina Tavares Timenetsky1, Ary Serpa Neto1,2. 1. Departamento de Terapia Intensiva, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil. 2. Departamento de Terapia Intensiva e Laboratório Experimental de Terapia Intensiva e Anestesiologia, Centro Médico Acadêmico, Universidade de Amsterdã - Amsterdã, Holanda.
Abstract
OBJECTIVE: To evaluate the efficacy of high-flow nasal cannula in the prevention of intubation and re-intubation in critically ill patients compared to conventional oxygen therapy or noninvasive ventilation. METHODS: This systematic review was performed through an electronic database search of articles published from 1966 to April 2018. The primary outcome was the need for intubation or re-intubation. The secondary outcomes were therapy escalation, mortality at the longest follow-up, hospital mortality and the need for noninvasive ventilation. RESULTS: Seventeen studies involving 3,978 patients were included. There was no reduction in the need for intubation or re-intubation with high-flow nasal cannula (OR 0.72; 95%CI 0.52 - 1.01; p = 0.056). There was no difference in the need for therapy escalation (OR 0.80, 95% CI 0.59 - 1.08, p = 0.144), mortality at the longest follow-up (OR 0.94; 95%CI 0.70 - 1.25; p = 0.667), hospital mortality (OR 0.84; 95%CI 0.56 - 1.26; p = 0.391) or noninvasive ventilation (OR 0.64, 95%CI 0.39 - 1.05, p = 0.075). In the trial sequential analysis, the number of events included was lower than the optimal information size with a global type I error > 0.05. CONCLUSION: In the present study and setting, high-flow nasal cannula was not associated with a reduction of the need for intubation or re-intubation in critically ill patients.
OBJECTIVE: To evaluate the efficacy of high-flow nasal cannula in the prevention of intubation and re-intubation in critically ill patients compared to conventional oxygen therapy or noninvasive ventilation. METHODS: This systematic review was performed through an electronic database search of articles published from 1966 to April 2018. The primary outcome was the need for intubation or re-intubation. The secondary outcomes were therapy escalation, mortality at the longest follow-up, hospital mortality and the need for noninvasive ventilation. RESULTS: Seventeen studies involving 3,978 patients were included. There was no reduction in the need for intubation or re-intubation with high-flow nasal cannula (OR 0.72; 95%CI 0.52 - 1.01; p = 0.056). There was no difference in the need for therapy escalation (OR 0.80, 95% CI 0.59 - 1.08, p = 0.144), mortality at the longest follow-up (OR 0.94; 95%CI 0.70 - 1.25; p = 0.667), hospital mortality (OR 0.84; 95%CI 0.56 - 1.26; p = 0.391) or noninvasive ventilation (OR 0.64, 95%CI 0.39 - 1.05, p = 0.075). In the trial sequential analysis, the number of events included was lower than the optimal information size with a global type I error > 0.05. CONCLUSION: In the present study and setting, high-flow nasal cannula was not associated with a reduction of the need for intubation or re-intubation in critically ill patients.
Authors: Salvatore Maurizio Maggiore; Francesco Antonio Idone; Rosanna Vaschetto; Rossano Festa; Andrea Cataldo; Federica Antonicelli; Luca Montini; Andrea De Gaetano; Paolo Navalesi; Massimo Antonelli Journal: Am J Respir Crit Care Med Date: 2014-08-01 Impact factor: 21.405
Authors: Holger J Schünemann; Joanne Khabsa; Karla Solo; Assem M Khamis; Romina Brignardello-Petersen; Amena El-Harakeh; Andrea Darzi; Anisa Hajizadeh; Antonio Bognanni; Anna Bak; Ariel Izcovich; Carlos A Cuello-Garcia; Chen Chen; Ewa Borowiack; Fatimah Chamseddine; Finn Schünemann; Gian Paolo Morgano; Giovanna E U Muti-Schünemann; Guang Chen; Hong Zhao; Ignacio Neumann; Jan Brozek; Joel Schmidt; Layal Hneiny; Leila Harrison; Marge Reinap; Mats Junek; Nancy Santesso; Rayane El-Khoury; Rebecca Thomas; Robby Nieuwlaat; Rosa Stalteri; Sally Yaacoub; Tamara Lotfi; Tejan Baldeh; Thomas Piggott; Yuan Zhang; Zahra Saad; Bram Rochwerg; Dan Perri; Eddy Fan; Florian Stehling; Imad Bou Akl; Mark Loeb; Paul Garner; Stephen Aston; Waleed Alhazzani; Wojciech Szczeklik; Derek K Chu; Elie A Akl Journal: Ann Intern Med Date: 2020-05-22 Impact factor: 25.391