Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Respir Care. 2020 Mar;65(3):369-376. doi: 10.4187/respcare.07205. Epub 2019 Nov 19.
Various studies have been performed to examine the effect of high-flow nasal cannula (HFNC) in immunocompromised patients with acute respiratory failure (ARF). However, the results were inconsistent. Thus, we conducted a meta-analysis to evaluate the effect of HFNC oxygen therapy in immunocompromised patients with ARF versus conventional oxygen therapy and noninvasive ventilation (NIV).
Relevant studies published prior to May 11, 2019, were systematically searched. The primary outcome was intubation rate; secondary outcomes were mortality (ICU mortality, in-hospital mortality, and 90-d mortality) and ICU-acquired infections. Data were pooled using the random effects model.
Of 832 identified studies, 8 were eligible for inclusion in our analysis ( = 2,167 subjects). HFNC was associated with lower intubation rates compared to conventional oxygen therapy (risk ratio [RR] 0.89, 95% CI 0.79-1.00, = .040), but we found no significant difference in the rate between HFNC and NIV (RR 0.74, 95% CI 0.46-1.19, = .22). We also found that HFNC did not increase the risk of ICU-acquired infections (RR 0.86, 95% CI 0.63-1.18, = .35). However, in comparison to other noninvasive therapies, HFNC exhibited no differences in ICU mortality (RR 0.82, 95% CI 0.58-1.17, = .28), in-hospital mortality (RR 0.92, 95% CI 0.74-1.15, = .48), or 90-d mortality (RR 0.98, 95% CI 0.81-1.18, = .82).
Our results suggest that HFNC may be a feasible alternative to NIV, with lower intubation rates and no increased risk for ICU-acquired infections compared to standard oxygen therapy. However, HFNC did not appear to reduce mortality in immunocompromised subjects with ARF compared with other noninvasive therapies. Further high-quality randomized controlled trials should be performed to confirm these findings.
已有多项研究旨在探讨高流量鼻导管（HFNC）在合并急性呼吸衰竭（ARF）的免疫功能低下患者中的作用。然而，这些研究结果并不一致。因此，我们进行了一项荟萃分析，以评估 HFNC 氧疗与常规氧疗和无创通气（NIV）在合并 ARF 的免疫功能低下患者中的疗效。
系统检索了截至 2019 年 5 月 11 日前发表的相关研究。主要结局为插管率；次要结局为死亡率（ICU 死亡率、住院死亡率和 90 天死亡率）和 ICU 获得性感染。采用随机效应模型对数据进行合并。
在 832 项已识别的研究中，有 8 项符合纳入标准（=2167 例患者）。与常规氧疗相比，HFNC 降低了插管率（风险比[RR]0.89，95%置信区间[CI]0.79-1.00，=0.040），但我们发现 HFNC 与 NIV 之间的插管率无显著差异（RR 0.74，95%CI0.46-1.19，=0.22）。我们还发现，HFNC 并未增加 ICU 获得性感染的风险（RR 0.86，95%CI0.63-1.18，=0.35）。然而，与其他非侵入性治疗方法相比，HFNC 在 ICU 死亡率（RR 0.82，95%CI0.58-1.17，=0.28）、住院死亡率（RR 0.92，95%CI0.74-1.15，=0.48）或 90 天死亡率（RR 0.98，95%CI0.81-1.18，=0.82）方面无差异。
我们的研究结果表明，与标准氧疗相比，HFNC 可能是一种可行的 NIV 替代方法，其插管率较低，且不会增加 ICU 获得性感染的风险。然而，与其他非侵入性治疗方法相比，HFNC 似乎并未降低合并 ARF 的免疫功能低下患者的死亡率。需要进一步开展高质量的随机对照试验来证实这些发现。
