Hideto Yasuda1,2, Hiromu Okano3, Takuya Mayumi4, Masaki Nakane5, Nobuaki Shime6. 1. Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan. yasudahideto@me.com. 2. Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. yasudahideto@me.com. 3. Department of Critical and Emergency Medicine, National Hospital Organization Yokohama Medical Center, 2-60-3, Harajyuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan. 4. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, 1-13, Takaramachi, Kanazawa-shi, Ishikawa, 920-0934, Japan. 5. Department of Emergency and Critical Care Medicine, Yamagata University Hospital, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-2331, Japan. 6. Department of Emergency and Critical Care Medicine, Postgraduate School of Medical Science, Hiroshima University Hospital, 3-2-1, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan.
Abstract
BACKGROUND: Noninvasive respiratory support devices may reduce the tracheal intubation rate compared with conventional oxygen therapy (COT). To date, few studies have compared high-flow nasal cannula (HFNC) use with noninvasive positive-pressure ventilation (NPPV). We conducted a network meta-analysis to compare the effectiveness of three respiratory support devices in patients with acute respiratory failure. METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥ 16 years with acute hypoxic respiratory failure and randomized-controlled trials that compared two different oxygenation devices (COT, NPPV, or HFNC) before tracheal intubation were included. A frequentist-based approach with a multivariate random-effects meta-analysis was used. The network meta-analysis was performed using the GRADE Working Group approach. The outcomes were short-term mortality and intubation rate. RESULTS: Among 5507 records, 27 studies (4618 patients) were included. The main cause of acute hypoxic respiratory failure was pneumonia. Compared with COT, NPPV and HFNC use tended to reduce mortality (relative risk, 0.88 and 0.93, respectively; 95% confidence intervals, 0.76-1.01 and 0.80-1.08, respectively; both low certainty) and lower the risk of endotracheal intubation (0.81 and 0.78; 0.72-0.91 and 0.68-0.89, respectively; both low certainty); however, short-term mortality or intubation rates did not differ (0.94 and 1.04, respectively; 0.78-1.15 and 0.88-1.22, respectively; both low certainty) between NPPV and HFNC use. CONCLUSION: NPPV and HFNC use are associated with a decreased risk of endotracheal intubation; however, there are no significant differences in short-term mortality. TRIAL REGISTRATION: PROSPERO (registration number: CRD42020139105 , 01/21/2020).
BACKGROUND: Noninvasive respiratory support devices may reduce the tracheal intubation rate compared with conventional oxygen therapy (COT). To date, few studies have compared high-flow nasal cannula (HFNC) use with noninvasive positive-pressure ventilation (NPPV). We conducted a network meta-analysis to compare the effectiveness of three respiratory support devices in patients with acute respiratory failure. METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥ 16 years with acute hypoxic respiratory failure and randomized-controlled trials that compared two different oxygenation devices (COT, NPPV, or HFNC) before tracheal intubation were included. A frequentist-based approach with a multivariate random-effects meta-analysis was used. The network meta-analysis was performed using the GRADE Working Group approach. The outcomes were short-term mortality and intubation rate. RESULTS: Among 5507 records, 27 studies (4618 patients) were included. The main cause of acute hypoxic respiratory failure was pneumonia. Compared with COT, NPPV and HFNC use tended to reduce mortality (relative risk, 0.88 and 0.93, respectively; 95% confidence intervals, 0.76-1.01 and 0.80-1.08, respectively; both low certainty) and lower the risk of endotracheal intubation (0.81 and 0.78; 0.72-0.91 and 0.68-0.89, respectively; both low certainty); however, short-term mortality or intubation rates did not differ (0.94 and 1.04, respectively; 0.78-1.15 and 0.88-1.22, respectively; both low certainty) between NPPV and HFNC use. CONCLUSION: NPPV and HFNC use are associated with a decreased risk of endotracheal intubation; however, there are no significant differences in short-term mortality. TRIAL REGISTRATION: PROSPERO (registration number: CRD42020139105 , 01/21/2020).
Authors: Andrés Esteban; Antonio Anzueto; Fernando Frutos; Inmaculada Alía; Laurent Brochard; Thomas E Stewart; Salvador Benito; Scott K Epstein; Carlos Apezteguía; Peter Nightingale; Alejandro C Arroliga; Martin J Tobin Journal: JAMA Date: 2002-01-16 Impact factor: 56.272
Authors: J-M Boles; J Bion; A Connors; M Herridge; B Marsh; C Melot; R Pearl; H Silverman; M Stanchina; A Vieillard-Baron; T Welte Journal: Eur Respir J Date: 2007-05 Impact factor: 16.671
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