B Rochwerg1,2,3, D Granton4, D X Wang5, Y Helviz6, S Einav6,7, J P Frat8,9,10, A Mekontso-Dessap11,12, A Schreiber13, E Azoulay14,15, A Mercat16, A Demoule17,18, V Lemiale14,15, A Pesenti19,20, E D Riviello21, T Mauri19,20, J Mancebo22, L Brochard23, K Burns23. 1. Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada. rochwerg@mcmaster.ca. 2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. rochwerg@mcmaster.ca. 3. Department of Medicine, Division of Critical Care, Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C3, Canada. rochwerg@mcmaster.ca. 4. Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada. 5. Schulich School of Medicine, Western University, London, ON, Canada. 6. General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel. 7. Faculty of Medicine, Hebrew University, Jerusalem, Israel. 8. CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France. 9. INSERM, CIC-1402, équipe ALIVE, Poitiers, France. 10. Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France. 11. Hôpitaux Universitaires Henri Mondor, Créteil, France. 12. Université Paris, Créteil, France. 13. Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada. 14. Hôpital Saint-Louis, Paris, France. 15. Center of Epidemiology and Biostatistics, Paris Diderot Sorbonne University, Paris, France. 16. Département de Médecine Intensive-Réanimation, CHU d'Angers, Université d'Angers, Angers, France. 17. Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France. 18. Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France. 19. Università degli Studi di Milano, Dipartimento di Fisopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy. 20. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 21. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. 22. Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain. 23. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure. METHODS: We performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods. RESULTS: We included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use. CONCLUSION: In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
BACKGROUND: This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure. METHODS: We performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods. RESULTS: We included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use. CONCLUSION: In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
Entities:
Keywords:
High flow nasal cannula; Meta-analysis; Respiratory failure
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