Yasuda Hideto, Okano Hiromu, Mayumi Takuya, Nakane Masaki, Shime Nobuaki
Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
J Intensive Care. 2021 Apr 12;9(1):32. doi: 10.1186/s40560-021-00539-7.
Noninvasive respiratory support devices may reduce the tracheal intubation rate compared with conventional oxygen therapy (COT). To date, few studies have compared high-flow nasal cannula (HFNC) use with noninvasive positive-pressure ventilation (NPPV). We conducted a network meta-analysis to compare the effectiveness of three respiratory support devices in patients with acute respiratory failure.
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥ 16 years with acute hypoxic respiratory failure and randomized-controlled trials that compared two different oxygenation devices (COT, NPPV, or HFNC) before tracheal intubation were included. A frequentist-based approach with a multivariate random-effects meta-analysis was used. The network meta-analysis was performed using the GRADE Working Group approach. The outcomes were short-term mortality and intubation rate.
Among 5507 records, 27 studies (4618 patients) were included. The main cause of acute hypoxic respiratory failure was pneumonia. Compared with COT, NPPV and HFNC use tended to reduce mortality (relative risk, 0.88 and 0.93, respectively; 95% confidence intervals, 0.76-1.01 and 0.80-1.08, respectively; both low certainty) and lower the risk of endotracheal intubation (0.81 and 0.78; 0.72-0.91 and 0.68-0.89, respectively; both low certainty); however, short-term mortality or intubation rates did not differ (0.94 and 1.04, respectively; 0.78-1.15 and 0.88-1.22, respectively; both low certainty) between NPPV and HFNC use.
NPPV and HFNC use are associated with a decreased risk of endotracheal intubation; however, there are no significant differences in short-term mortality.
PROSPERO (registration number: CRD42020139105 , 01/21/2020).
与传统氧疗（COT）相比，无创呼吸支持设备可能会降低气管插管率。迄今为止，很少有研究比较高流量鼻导管（HFNC）与无创正压通气（NPPV）的使用情况。我们进行了一项网状荟萃分析，以比较三种呼吸支持设备对急性呼吸衰竭患者的有效性。
检索Cochrane对照试验中央登记库、MEDLINE、EMBASE和Ichushi数据库。纳入的研究包括年龄≥16岁的急性低氧性呼吸衰竭成人患者，以及在气管插管前比较两种不同氧疗设备（COT、NPPV或HFNC）的随机对照试验。采用基于频率论的多变量随机效应荟萃分析方法。使用GRADE工作组方法进行网状荟萃分析。结局指标为短期死亡率和插管率。
在5507条记录中，纳入了27项研究（4618例患者）。急性低氧性呼吸衰竭的主要病因是肺炎。与COT相比，使用NPPV和HFNC往往会降低死亡率（相对风险分别为0.88和0.93；95%置信区间分别为0.76 - 1.01和0.80 - 1.08；均为低确定性），并降低气管插管风险（分别为0.81和0.78；0.72 - 0.91和0.68 - 0.89；均为低确定性）；然而，NPPV和HFNC的短期死亡率或插管率没有差异（分别为0.94和1.04；0.78 - 1.15和0.88 - 1.22；均为低确定性）。
使用NPPV和HFNC与气管插管风险降低相关；然而，短期死亡率没有显著差异。
PROSPERO（注册号：CRD42020139105，2020年1月21日）。
