High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis
CCCF ePoster library. Leeies M. Oct 31, 2016; 150891; 13
Dr. Murdoch Leeies
Dr. Murdoch Leeies
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Topic: Systematic Review, Meta-analysis, or Meta-synthesis

High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis


Leeies, Murdoch 1,2,3; Flynn, Eric1; Turgeon, Alexis F4; Paunovic, Bojan2; Loewen, Hal5; Rabbani, Rasheda3,6; Abou-Setta, Ahmed M3,6; Ferguson, Niall D7; Zarychanski, Ryan2,3,6

1
Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
2 Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
3 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
4 Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Québec City, Québec, Canada
5 Neil John Mclean Library, University of Manitoba, Winnipeg, Manitoba, Canada
6 George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
7 Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital; Toronto General Research Institute; Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
 



Abstract:

Objective: To evaluate the efficacy and safety of high-flow oxygen via nasal cannulae in patients with acute, hypoxemic respiratory failure.
Design: Systematic review and meta-analysis.
Data Sources: Randomized controlled trials from CENTRAL, EMBASE, MEDLINE, Scopus and the International Clinical Trials Registry Platform (inception to April 2016), conference proceedings and reference lists of relevant articles.
Study Selection and Data Extraction: Two reviewers independently screened, identified and extracted trial-level data from prospective randomized controlled trials investigating high-flow oxygen via nasal cannulae in patients with acute, hypoxemic respiratory failure. Internal validity was assessed in duplicate using the Risk of Bias tool. The strength of evidence was assessed in duplicate using the Grading of Recommendations Assessment, Development, and Evaluation framework (GRADE). Our primary outcome was mortality. Secondary outcomes included endotracheal intubation, dyspnea, the PaO2:FiO2 ratio, PaCO2 and pH.  Safety outcomes included respiratory arrest, delirium and skin breakdown.
Measurement and Main Results: From 2023 screened citations, we identified seven trials (1771 patients) meeting inclusion criteria. All trials were at high risk of bias due to lack of blinding.  There was no evidence for a differential mortality risk in patients receiving high-flow oxygen via nasal cannulae vs. non-invasive ventilation and/or standard oxygen therapy (RR 1.01; 95% CI 0.69 to 1.48; I2 = 63%; five trials; 1629 patients).  In a priori specified sub-group analyses of high-flow oxygen via nasal cannulae compared to non-invasive ventilation or standard oxygen therapy individually, significant mortality differences were not observed.  Measures of patient reported dyspnea and tolerability were heterogeneous.  The PaO2:FiO2 ratio at 6 to12 hours was significantly lower in patients receiving oxygen via high-flow nasal cannulae compared to non-invasive ventilation or standard oxygen for hypoxemic respiratory failure (MD -53.34; 95% CI -71.95 to -34.72; I2 = 61%, 1143 patients).  There were no significant differences in other physiologic variables (pH, PaCO2), or rates of intubation or cardio-respiratory arrest.  Delirium and skin-breakdown were sparsely reported.
Conclusions: In patients with acute hypoxemic respiratory failure high-flow oxygen via nasal cannulae was not associated with a significant difference in mortality compared to non-invasive ventilation or standard oxygen. Prospective trials designed and powered to more precisely evaluate the efficacy and safety of high-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure are required.
 


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