Department of Medicine, McMaster University, Hamilton, ON, Canada.
Schulich School of Medicine, Western University, London, ON, Canada.
Crit Care Med. 2020 Apr;48(4):571-578. doi: 10.1097/CCM.0000000000004217.
The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.
We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).
We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.
Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, PaO2 before and after intubation, PaCO2 after intubation, ICU length of stay, and short-term mortality.
We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68-1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71-1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), PaO2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or PaO2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation PaCO2, ICU length of stay, or 28-day mortality.
We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.
尽管有许多随机临床试验，但在插管期间和插管前高流量鼻导管的作用仍不清楚。我们的目的是进行系统评价和荟萃分析，以检查高流量鼻导管在围插管期的益处。
我们对相关数据库（MEDLINE、EMBASE 和 Web of Science）进行了全面检索。
我们纳入了比较围插管期高流量鼻导管与其他非侵入性氧输送系统的随机临床试验。
我们的主要结局是严重的低氧血症（定义为插管期间外周血氧饱和度读数<80%）。次要结局包括围插管期并发症、无通气时间、插管前和插管后 PaO2、插管后 PaCO2、ICU 住院时间和短期死亡率。
我们纳入了 10 项随机临床试验（n=1017 名患者）。高流量鼻导管对围插管期低氧血症的发生率无影响（相对风险，0.98；95%CI，0.68-1.42；0.3%绝对风险降低，中等确定性）、严重并发症（相对风险，0.87；95%CI，0.71-1.06）、无通气时间（高流量鼻导管高 10.3s；95%CI，低 11.0s 至高 31.7s）、预氧合后测量的 PaO2（平均差异，高 3.6mmHg；95%CI，低 3.5mmHg 至高 10.7mmHg）或插管后测量的 PaO2（平均差异，高 27.0mmHg；95%CI，低 13.2mmHg 至高 67.2mmHg），与常规氧疗相比。对插管后 PaCO2、ICU 住院时间或 28 天死亡率也没有影响。
我们发现中等至低确定性证据表明，与常规氧疗相比，在围插管期使用高流量鼻导管可能对严重低氧血症、严重并发症、无通气时间、氧合、ICU 住院时间或总体生存率没有影响。
