Zayed Yazan, Banifadel Momen, Barbarawi Mahmoud, Kheiri Babikir, Chahine Adam, Rashdan Laith, Haykal Tarek, Samji Varun, Armstrong Emily, Bachuwa Ghassan, Al-Sanouri Ibrahim, Seedahmed Elfateh, Hernandez Dawn-Alita
Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA.
Internal Medicine Department, 89021University of Toledo, Toledo, OH, USA.
J Intensive Care Med. 2020 Nov;35(11):1216-1225. doi: 10.1177/0885066619844713. Epub 2019 May 2.
Acute hypoxemic respiratory failure (AHRF) is a leading cause of intensive care unit (ICU) admission among immunocompromised patients. Invasive mechanical ventilation is associated with increased morbidity and mortality.
To evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in immunocompromised patients with AHRF.
Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to December 2018. We included all randomized controlled trials (RCTs) comparing different modalities of initial oxygenation strategies in immunocompromised patients with AHRF. Our primary outcome was the need for intubation and invasive mechanical ventilation while secondary outcomes were ICU acquired infections and short- and long-term mortality. Data were extracted separately and independently by 2 reviewers. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrIs).
Nine RCTs were included (1570 patients, mean age 61.1 ± 13.8 years with 64% male). Noninvasive ventilation was associated with a significantly reduced intubation rate compared with standard oxygen therapy (OR: 0.53; 95% CrI: 0.26-0.91). There were no significant reductions of intubation between NIV versus HFNC (OR: 0.83; 95% CrI: 0.35-2.11) or HFNC versus standard oxygen therapy (OR: 0.65; 95% CrI: 0.26-1.24). There were no significant differences between all groups regarding short-term (28-day or ICU) mortality or long-term (90-day or hospital) mortality or ICU-acquired infections ( > 0.05).
Among immunocompromised patients with AHRF, NIV was associated with a significant reduction of intubation compared with standard oxygen therapy. There were no significant differences among all oxygenation strategies regarding mortality and ICU-acquired infections.
急性低氧血症性呼吸衰竭（AHRF）是免疫功能低下患者入住重症监护病房（ICU）的主要原因。有创机械通气与发病率和死亡率增加相关。
评估包括无创通气（NIV）、高流量鼻导管吸氧（HFNC）和传统氧疗在内的各种氧合策略对免疫功能低下的AHRF患者的疗效。
检索了包括PubMed、Embase和Cochrane图书馆在内的电子数据库，检索时间从建库至2018年12月。我们纳入了所有比较免疫功能低下的AHRF患者初始氧合策略不同方式的随机对照试验（RCT）。我们的主要结局是插管和有创机械通气的需求，次要结局是ICU获得性感染以及短期和长期死亡率。由2名研究者分别独立提取数据。我们进行了贝叶斯网络荟萃分析以计算比值比（OR）和贝叶斯95%可信区间（CrI）。
纳入了9项RCT（1570例患者，平均年龄61.1±13.8岁，男性占64%）。与标准氧疗相比，无创通气与插管率显著降低相关（OR：0.53；95% CrI：0.26 - 0.91）。无创通气与高流量鼻导管吸氧之间（OR：0.83；95% CrI：0.3
