High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis
Por:
Rochwerg, B, Granton, D, Wang, DX, Helviz, Y, Einav, S, Frat, JP, Mekontso-Dessap, A, Schreiber, A, Azoulay, E, Mercat, A, Demoule, A, Lemiale, V, Pesenti, A, Riviello, ED, Mauri, T, Mancebo, J, Brochard, L, Burns, K
Publicada:
1 may 2019
Resumen:
BackgroundThis systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure.MethodsWe 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.ResultsWe 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] 1.38days more, 95% CI 0.90days fewer to 3.66days more, low certainty), hospital length of stay (MD 0.85days fewer, 95% CI 2.07days fewer to 0.37days 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.ConclusionIn patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
Filiaciones:
Rochwerg, B:
McMaster Univ, Michael G De Groote Sch Med, Hamilton, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Juravinski Hosp, Dept Med, Div Crit Care, 711 Concess St, Hamilton, ON L8V 1C3, Canada
Granton, D:
McMaster Univ, Michael G De Groote Sch Med, Hamilton, ON, Canada
Wang, DX:
Western Univ, Schulich Sch Med, London, ON, Canada
Helviz, Y:
Shaare Zedek Med Ctr, Gen Intens Care Unit, Jerusalem, Israel
Einav, S:
Shaare Zedek Med Ctr, Gen Intens Care Unit, Jerusalem, Israel
Hebrew Univ Jerusalem, Fac Med, Jerusalem, Israel
Frat, JP:
CHU Poitiers, Med Intens Reanimat, Poitiers, France
INSERM, CIC 1402, Equipe ALIVE, Poitiers, France
Univ Poitiers, Fac Med & Pharm Poitiers, Poitiers, France
Mekontso-Dessap, A:
Hop Univ Henri Mondor, Creteil, France
Univ Paris, Creteil, France
Schreiber, A:
Univ Hlth Network, Dept Med, Div Respirol, Toronto, ON, Canada
Azoulay, E:
Hop St Louis, Paris, France
Paris Diderot Sorbonne Univ, Ctr Epidemiol & Biostat, Paris, France
Mercat, A:
Univ Angers, Dept Med Intens Reanimat, CHU Angers, Angers, France
Demoule, A:
Grp Hosp Pitie Salpetriere Charles Foix, AP HP, Dept R3S, Serv Pneumol & Reanimat Med, Paris, France
Sorbonne Univ, INSERM, UMRS1158, Neurophysiol Resp Expt & Clin, Paris, France
Lemiale, V:
Hop St Louis, Paris, France
Paris Diderot Sorbonne Univ, Ctr Epidemiol & Biostat, Paris, France
Pesenti, A:
Univ Milan, Dipartimento Fisopatol Med Chirurg & Trapianti, Milan, Italy
Univ Milan, Dept Anesthesia Crit Care & Emergency, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy
Riviello, ED:
Beth Israel Deaconess Med Ctr, Div Pulm Crit Care & Sleep Med, Boston, MA 02215 USA
Harvard Med Sch, Boston, MA 02115 USA
Mauri, T:
Univ Milan, Dipartimento Fisopatol Med Chirurg & Trapianti, Milan, Italy
Univ Milan, Dept Anesthesia Crit Care & Emergency, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy
Mancebo, J:
Hosp Univ St Pau, Serv Med Intens, Barcelona, Spain
Brochard, L:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Burns, K:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
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