Zayed Yazan, Kheiri Babikir, Barbarawi Mahmoud, Rashdan Laith, Gakhal Inderdeep, Ismail Esra'a, Kerbage Josiane, Rizk Fatima, Shafi Saadia, Bala Areeg, Sidahmed Shima, Bachuwa Ghassan, Seedahmed Elfateh
Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA.
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon USA.
J Intensive Care. 2020 Jul 17;8:51. doi: 10.1186/s40560-020-00468-x. eCollection 2020.
Postoperative respiratory failure is associated with increased perioperative complications. Our aim is to compare outcomes between non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen in patients at high-risk for or with established postoperative respiratory failure.
Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to September 2019. We included only randomized controlled trials (RCTs) that compared NIV, HFNC, and standard oxygen in patients at high risk for or with established postoperative respiratory failure. We performed a Bayesian network meta-analysis to calculate the odds ratio (OR) and Bayesian 95% credible intervals (CrIs).
Nine RCTs representing 1865 patients were included (the mean age was 61.6 ± 10.2 and 64.4% were males). In comparison with standard oxygen, NIV was associated with a significant reduction in intubation rate (OR 0.23; 95% Cr.I. 0.10-0.46), mortality (OR 0.45; 95% Cr.I. 0.27-0.71), and intensive care unit (ICU)-acquired infections (OR 0.43, 95% Cr.I. 0.25-0.70). Compared to standard oxygen, HFNC was associated with a significant reduction in intubation rate (OR 0.28, 95% Cr.I. 0.08-0.76) and ICU-acquired infections (OR 0.41; 95% Cr.I. 0.20-0.80), but not mortality (OR 0.58; 95% Cr.I. 0.26-1.22). There were no significant differences between HFNC and NIV regarding different outcomes. In a subgroup analysis, we observed a mortality benefit with NIV over standard oxygen in patients undergoing cardiothoracic surgeries but not in abdominal surgeries. Furthermore, in comparison with standard oxygen, NIV and HFNC were associated with lower intubation rates following cardiothoracic surgeries while only NIV reduced the intubation rates following abdominal surgeries.
Among patients with post-operative respiratory failure, HFNC and NIV were associated with significantly reduced rates of intubation and ICU-acquired infections compared with standard oxygen. Moreover, NIV was associated with reduced mortality in comparison with standard oxygen.
术后呼吸衰竭与围手术期并发症增加相关。我们的目的是比较无创通气（NIV）、高流量鼻导管吸氧（HFNC）和标准吸氧对术后呼吸衰竭高危或已发生术后呼吸衰竭患者的治疗效果。
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2019年9月。我们仅纳入了比较NIV、HFNC和标准吸氧对术后呼吸衰竭高危或已发生术后呼吸衰竭患者治疗效果的随机对照试验（RCT）。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（CrIs）。
纳入了9项RCT，共1865例患者（平均年龄61.6±10.2岁，男性占64.4%）。与标准吸氧相比，NIV与插管率显著降低相关（OR 0.23；95% Cr.I. 0.10 - 0.46）、死亡率显著降低（OR 0.45；95% Cr.I. 0.27 - 0.71）以及重症监护病房（ICU）获得性感染显著降低（OR 0.43，95% Cr.I. 0.25 - 0.70）。与标准吸氧相比，HFNC与插管率显著降低（OR 0.28，95% Cr.I. 0.08 - 0.76）和ICU获得性感染显著降低（OR 0.41；95% Cr.I. 0.20 - 0.80）相关，但与死亡率无关（OR 0.58；95% Cr.I. 0.26 - 1.22）。HFNC和NIV在不同结局方面无显著差异。在亚组分析中，我们观察到在接受心胸手术的患者中，NIV比标准吸氧有降低死亡率的益处，但在腹部手术患者中则没有。此外，与标准吸氧相比，NIV和HFNC与心胸手术后较低的插管率相关，而只有NIV降低了腹部手术后的插管率。
在术后呼吸衰竭患者中，与标准吸氧相比，HFNC和NIV与插管率及ICU获得性感染率显著降低相关。此外，与标准吸氧相比，NIV与死亡率降低相关。
