Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis
Por:
Chaudhuri, D, Granton, D, Wang, DX, Einav, S, Helviz, Y, Mauri, T, Ricard, JD, Mancebo, J, Frat, JP, Jog, S, Hernandez, G, Maggiore, SM, Hodgson, C, Jaber, S, Brochard, L, Burns, KEA, Rochwerg, B
Publicada:
1 abr 2020
Resumen:
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, Pao(2) before and after intubation, Paco(2) 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), Pao(2) measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao(2) 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 Paco(2), 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.
Filiaciones:
Chaudhuri, D:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Granton, D:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Wang, DX:
Western Univ, Schulich Sch Med, London, ON, Canada
Einav, S:
Shaare Zedek Med Ctr, Gen Intens Care Unit, Jerusalem, Israel
Hebrew Univ Jerusalem, Fac Med, Jerusalem, Israel
Helviz, Y:
Shaare Zedek Med Ctr, Gen Intens Care Unit, Jerusalem, Israel
Mauri, T:
Univ Milan, Dipartimento Fisopatol Med Chirurg & Trapianti, Milan, Italy
Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Ricard, JD:
Hop Louis Mourier, AP HP, Serv Reanimat Medicochirurg, Colombes, France
Univ Paris Diderot, Sorbonne Paris Cite, IAME, UMR 1137, Paris, France
Mancebo, J:
Hosp Univ St Pau, Serv Med Intens, Barcelona, Spain
Frat, JP:
CHU Poitiers, Med Intens Reanimat, Poitiers, France
INSERM, CIC 1402, Equipe ALIVE, Poitiers, France
Univ Poitiers, Fac Med & Pharm Poitiers, Poitiers, France
Jog, S:
Deenanath Mangeshkar Hosp & Res Ctr, Dept Intens Care Med, Pune, Maharashtra, India
Hernandez, G:
Hosp Infanta Sofia, Intens Care Unit, Madrid, Spain
Maggiore, SM:
Gabriele dAnnunzio Univ Chieti Pescara, Dept Med Oral & Biotechnol Sci, Chieti, Italy
SS Annunziata Hosp, Dept Anesthesiol & Crit Care, Chieti, Italy
Hodgson, C:
Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia
Jaber, S:
Montpellier Univ, Univ Hosp Montpellier, Montpellier, France
Montpellier Univ, St Eloi Hosp, Montpellier, France
Brochard, L:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Burns, KEA:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Rochwerg, B:
McMaster Univ, Dept Med, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Green Submitted
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