Monro-Somerville Thalia, Sim Malcolm, Ruddy James, Vilas Mark, Gillies Michael A
1Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.2Department of Anaesthesia, Critical Care and Pain Medicine, Queen Elizabeth University Hospital, Glasgow, United Kingdom.3Department of Anaesthesia, Critical Care and Pain Medicine, Monklands General Hospital, Airdrie, United Kingdom.
Crit Care Med. 2017 Apr;45(4):e449-e456. doi: 10.1097/CCM.0000000000002091.
High-flow nasal cannulae are used in adults with or at risk of acute respiratory failure. We conducted a systematic review and meta-analysis to evaluate the evidence for their use in this setting.
Ovid Medline, Embase, and Cochrane Database of Systematic Reviews.
Databases were searched for randomized controlled trials comparing administration of high-flow nasal cannulae with usual care (i.e., conventional oxygen therapy or noninvasive ventilation) in adults with respiratory failure. The primary outcome was hospital mortality; the rate of intubation and assessment of delirium and comfort were secondary outcomes.
One hundred forty-seven nonduplicate citations were screened, 32 underwent full screening and data extraction, and 14 trials were eligible for inclusion in the review. Nine trials were used in the meta-analysis, including a total of 2,507 subjects.
When high-flow nasal cannulae were compared with usual care, there was no difference in mortality (high-flow nasal cannulae, 60/1,006 [6%] vs usual care, 90/1,106 [8.1%]) (n = 2,112; p = 0.29; I, 25%; fixed effect model: odds ratio, 0.83; 95% CI, 0.58-1.17) or rate of intubation (high-flow nasal cannulae, 119/1,207 [9.9%] vs usual care, 204/1,300 [15.7%]) (n = 2,507; p = 0.08; I, 53%; random effect model: odds ratio, 0.63; 95% CI, 0.37-1.06). A qualitative analysis of 13 studies on tolerability and comfort suggested that high-flow nasal cannulae are associated with improved patient comfort and dyspnea scores. Trial sequential analyses on primary and secondary outcomes suggested that required information size was not reached.
No difference in mortality or intubation was detected in patients with acute respiratory failure treated with high-flow nasal cannulae compared with usual care. High-flow nasal cannulae seem well tolerated by patients. Further large randomized controlled trials are required to evaluate their utility in this setting.
高流量鼻导管用于患有急性呼吸衰竭或有急性呼吸衰竭风险的成人患者。我们进行了一项系统评价和荟萃分析，以评估其在这种情况下使用的证据。
Ovid Medline、Embase和Cochrane系统评价数据库。
检索数据库，查找比较高流量鼻导管与常规治疗（即传统氧疗或无创通气）在呼吸衰竭成人患者中的应用的随机对照试验。主要结局是医院死亡率；插管率以及谵妄和舒适度评估为次要结局。
筛选了147条非重复引文，32条进行了全面筛选和数据提取，14项试验符合纳入本评价的标准。9项试验用于荟萃分析，共纳入2507名受试者。
将高流量鼻导管与常规治疗进行比较时，死亡率无差异（高流量鼻导管组，60/1006例[6%]，常规治疗组，90/1106例[8.1%]）（n = 2112；p = 0.29；I² = 25%；固定效应模型：比值比，0.83；95%可信区间，0.58 - 1.17）或插管率无差异（高流量鼻导管组，119/1207例[9.9%]，常规治疗组，204/1300例[15.7%]）（n = 2507；p = 0.08；I² = 53%；随机效应模型：比值比，0.63；95%可信区间，0.37 - 1.06）。对13项关于耐受性和舒适度的研究进行的定性分析表明，高流量鼻导管与患者舒适度和呼吸困难评分改善相关。对主要和次要结局的序贯试验分析表明，未达到所需的信息量。
与常规治疗相比，在接受高流量鼻导管治疗的急性呼吸衰竭患者中，未检测到死亡率或插管率有差异。患者对高流量鼻导管的耐受性似乎良好。需要进一步开展大型随机对照试验来评估其在这种情况下的效用。
