Okano Hiromu, Sakuraya Masaaki, Masuyama Tomoyuki, Kimata Shunsuke, Hokari Satoshi
Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan.
International University of Health and Welfare Graduate School of Public Health, 4-1-26 Akasaka, Minato City, Tokyo, 107-8402, Japan.
JA Clin Rep. 2022 May 6;8(1):34. doi: 10.1186/s40981-022-00525-4.
Network meta-analyses (NMAs) of respiratory management strategies for acute hypoxemic respiratory failure (AHRF) have been reported, but no previous study has compared noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), standard oxygenation therapy (SOT), and invasive mechanical ventilation (IMV) for de novo AHRF. Therefore, we conducted an NMA to assess the effectiveness of these four respiratory strategies in patients with de novo AHRF.
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥18 years with AHRF and RCTs that compared two different oxygenation techniques (SOT, NIV, HFNO, or IMV) were selected. A frequentist-based approach with multivariate random-effects meta-analysis was used. The outcomes were mortality and intubation rates.
Among the 14,263 records initially identified, 25 studies (3302 patients) were included. In the analysis of mortality, compared to SOT, NIV (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.61-0.95) reduced mortality; however, IMV (RR, 1.01; 95% CI, 0.57-1.78) and HFNO (RR, 0.89; 95% CI, 0.66-1.20) did not. For assessments of the intubation incidence, compared to SOT, NIV use (RR, 0.63; 95% CI, 0.51-0.79) was associated with a reduction in intubation, but HFNO (RR, 0.82; 95% CI, 0.61-1.11) was not significant.
Our NMA demonstrated that only NIV showed clinical benefits compared with SOT as an initial respiratory strategy for de novo AHRF. Further investigation, especially comparison with HFNO, is warranted.
PROSPERO (registration number: CRD42020213948 , 11/11/2020).
已有关于急性低氧性呼吸衰竭（AHRF）呼吸管理策略的网状Meta分析（NMA）报道，但此前尚无研究比较无创通气（NIV）、高流量鼻导管吸氧（HFNO）、标准氧疗（SOT）和有创机械通气（IMV）用于新发AHRF的效果。因此，我们进行了一项NMA，以评估这四种呼吸策略对新发AHRF患者的有效性。
检索Cochrane对照试验中心注册库、MEDLINE、EMBASE和日本医学中央杂志数据库。纳入年龄≥18岁的AHRF成人患者以及比较两种不同氧疗技术（SOT、NIV、HFNO或IMV）的随机对照试验（RCT）。采用基于频率学派的多变量随机效应Meta分析方法。结局指标为死亡率和插管率。
在最初识别的14263条记录中，纳入了25项研究（3302例患者）。在死亡率分析中，与SOT相比，NIV（风险比[RR]，0.76；95%置信区间[CI]，0.61 - 0.95）降低了死亡率；然而，IMV（RR，1.01；95%CI，0.57 - 1.78）和HFNO（RR，0.89；95%CI，0.66 - 1.20）未降低死亡率。对于插管发生率评估，与SOT相比，使用NIV（RR，0.63；95%CI，0.51 - 0.79）与插管减少相关，但HFNO（RR，0.82；95%CI，0.61 - 1.11）无显著差异。
我们的NMA表明，作为新发AHRF的初始呼吸策略，与SOT相比，只有NIV显示出临床益处。有必要进行进一步研究，尤其是与HFNO的比较。
PROSPERO（注册号：CRD42020213948，2020年11月11日）。
