Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Syst Rev. 2020 Apr 26;9(1):95. doi: 10.1186/s13643-020-01363-0.
Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and is associated with high mortality. Noninvasive oxygenation strategies such as high-flow nasal cannula, standard oxygen therapy, and noninvasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network meta-analysis is to summarize the evidence and compare the effect of noninvasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure.
We will search key databases for randomized controlled trials assessing the effect of noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology.
This study will help to guide clinical decision-making when caring for adult patients with acute hypoxemic respiratory failure and improve our understanding of the limitations of the available literature assessing noninvasive oxygenation strategies in acute hypoxemic respiratory failure.
PROSPERO CRD42019121755.
急性低氧性呼吸衰竭是重症监护病房收治的主要原因之一，与高死亡率相关。高流量鼻导管、标准氧疗和无创通气（通过面罩或头盔接口提供）等非侵入性氧合策略在这些患者中广泛应用。目前尚不清楚这些干预措施中哪一种更能有效降低有创机械通气和死亡率。本网络荟萃分析的主要目的是总结证据，并比较急性低氧性呼吸衰竭患者的非侵入性氧合策略对死亡率和有创机械通气需求的影响。
我们将搜索关键数据库，以评估非侵入性氧合策略对成人急性低氧性呼吸衰竭患者的影响的随机对照试验。我们将排除主要关注慢性阻塞性肺疾病急性加重或心源性肺水肿的研究。主要结局将是全因死亡率（最长可达 90 天）。次要结局将是接受有创机械通气（最长可达 30 天）。我们将使用 Cochrane 偏倚风险工具评估每个结局的偏倚风险。将进行贝叶斯网络荟萃分析，以获得头对头比较的汇总估计值。我们将报告成对和网络荟萃分析治疗效果估计值作为风险比和 95%可信区间。将进行亚组分析，检查包括免疫功能低下宿主在内的关键人群。将进行敏感性分析，排除那些偏倚风险高和急性呼吸衰竭病因不同的研究。我们将使用 GRADE 方法评估效果估计的确定性。
本研究将有助于指导护理成人急性低氧性呼吸衰竭患者时的临床决策，并提高我们对评估急性低氧性呼吸衰竭中非侵入性氧合策略的现有文献的局限性的理解。
PROSPERO CRD42019121755。
