Dipayan Chaudhuri1, David Granton1, Dominic Xiang Wang2, Sharon Einav3,4, Yigal Helviz3, Tommaso Mauri5,6, Jean-Damien Ricard7,8, Jordi Mancebo9, Jean-Pierre Frat10,11,12, Sameer Jog13, Gonzalo Hernandez14, Salvatore M Maggiore15, Carol Hodgson16, Samir Jaber17, Laurent Brochard18, Karen E A Burns18, Bram Rochwerg1,19. 1. Department of Medicine, McMaster University, Hamilton, ON, Canada. 2. Schulich School of Medicine, Western University, London, ON, Canada. 3. General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel. 4. Faculty of Medicine, Hebrew University, Jerusalem, Israel. 5. Dipartimento di fisopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Milan, Italy. 6. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 7. Assistance Publique-Hôpital de Paris, Service de Réanimation Médico-chirurgicale, Hôpital Louis Mourier, Colombes, France. 8. Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France. 9. Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain. 10. CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France. 11. INSERM, CIC-1402, équipe ALIVE, Poitiers, France. 12. Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France. 13. Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India. 14. Intensive Care Unit, Hospital Infanta Sofía, Madrid, Spain. 15. Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, AND Department of Anesthesiology and Critical Care, SS. Annunziata Hospital, Chieti, Italy. 16. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 17. University Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France. 18. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 19. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVE: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period. DATA SOURCES: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science). STUDY SELECTION: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period. DATA EXTRACTION: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, PaO2 before and after intubation, PaCO2 after intubation, ICU length of stay, and short-term mortality. DATA SYNTHESIS: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68-1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71-1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), PaO2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or PaO2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation PaCO2, ICU length of stay, or 28-day mortality. CONCLUSIONS: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.
OBJECTIVE: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period. DATA SOURCES: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science). STUDY SELECTION: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period. DATA EXTRACTION: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, PaO2 before and after intubation, PaCO2 after intubation, ICU length of stay, and short-term mortality. DATA SYNTHESIS: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68-1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71-1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), PaO2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or PaO2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation PaCO2, ICU length of stay, or 28-day mortality. CONCLUSIONS: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.
Authors: Erin M Vaughan; Kevin P Seitz; David R Janz; Derek W Russell; James Dargin; Derek J Vonderhaar; Aaron M Joffe; Jason R West; Wesley H Self; Todd W Rice; Matthew W Semler; Jonathan D Casey Journal: J Intensive Care Med Date: 2021-12-13 Impact factor: 2.889
Authors: Bram Rochwerg; Sharon Einav; Dipayan Chaudhuri; Jordi Mancebo; Tommaso Mauri; Yigal Helviz; Ewan C Goligher; Samir Jaber; Jean-Damien Ricard; Nuttapol Rittayamai; Oriol Roca; Massimo Antonelli; Salvatore Maurizio Maggiore; Alexandre Demoule; Carol L Hodgson; Alain Mercat; M Elizabeth Wilcox; David Granton; Dominic Wang; Elie Azoulay; Lamia Ouanes-Besbes; Gilda Cinnella; Michela Rauseo; Carlos Carvalho; Armand Dessap-Mekontso; John Fraser; Jean-Pierre Frat; Charles Gomersall; Giacomo Grasselli; Gonzalo Hernandez; Sameer Jog; Antonio Pesenti; Elisabeth D Riviello; Arthur S Slutsky; Renee D Stapleton; Daniel Talmor; Arnaud W Thille; Laurent Brochard; Karen E A Burns Journal: Intensive Care Med Date: 2020-11-17 Impact factor: 17.440