高流量鼻导管可降低 COVID-19 合并急性呼吸衰竭患者的插管率：一项荟萃分析和系统评价。

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review.

机构信息

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.

Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China

出版信息

BMJ Open. 2023 Mar 30;13(3):e067879. doi: 10.1136/bmjopen-2022-067879.

OBJECTIVE

This study aimed to investigate the effect of high-flow nasal cannula therapy (HFNC) versus conventional oxygen therapy (COT) on intubation rate, 28-day intensive care unit (ICU) mortality, 28-day ventilator-free days (VFDs) and ICU length of stay (ICU LOS) in adult patients with acute respiratory failure (ARF) associated with COVID-19.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Web of Science, Cochrane Library and Embase up to June 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Only randomised controlled trials or cohort studies comparing HFNC with COT in patients with COVID-19 were included up to June 2022. Studies conducted on children or pregnant women, and those not published in English were excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened the titles, abstracts and full texts. Relevant information was extracted and curated in the tables. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to assess the quality of randomised controlled trials or cohort studies. Meta-analysis was conducted using RevMan V.5.4 computer software using a random effects model with a 95% CI. Heterogeneity was assessed using Cochran's Q test (χ) and Higgins I statistics, with subgroup analyses to account for sources of heterogeneity.

RESULTS

Nine studies involving 3370 (1480 received HFNC) were included. HFNC reduced the intubation rate compared with COT (OR 0.44, 95% CI 0.28 to 0.71, p=0.0007), decreased 28-day ICU mortality (OR 0.54, 95% CI 0.30 to 0.97, p=0.04) and improved 28-day VFDs (mean difference (MD) 2.58, 95% CI 1.70 to 3.45, p<0.00001). However, HFNC had no effect on ICU LOS versus COT (MD 0.52, 95% CI -1.01 to 2.06, p=0.50).

CONCLUSIONS

Our study indicates that HFNC may reduce intubation rate and 28-day ICU mortality, and improve 28-day VFDs in patients with ARF due to COVID-19 compared with COT. Large-scale randomised controlled trials are necessary to validate our findings.

PROSPERO REGISTRATION NUMBER

CRD42022345713.

目的

本研究旨在探讨高流量鼻导管治疗（HFNC）与常规氧疗（COT）对 COVID-19 相关急性呼吸衰竭（ARF）成人患者插管率、28 天重症监护病房（ICU）死亡率、28 天无呼吸机天数（VFDs）和 ICU 住院时间（ICU LOS）的影响。

设计

系统评价和荟萃分析。

数据来源

截至 2022 年 6 月，PubMed、Web of Science、Cochrane 图书馆和 Embase。

纳入研究的选择标准

仅纳入比较 COVID-19 患者 HFNC 与 COT 的随机对照试验或队列研究。排除针对儿童或孕妇的研究以及未以英文发表的研究。

数据提取和综合

两名评审员独立筛选标题、摘要和全文。相关信息提取并整理在表格中。使用 Cochrane 协作工具和纽卡斯尔-渥太华量表评估随机对照试验或队列研究的质量。使用 RevMan V.5.4 计算机软件进行荟萃分析，采用随机效应模型，95%CI。使用 Cochran's Q 检验（χ2）和 Higgins I 统计量评估异质性，并进行亚组分析以解释异质性来源。

结果

纳入了 9 项研究，共涉及 3370 名患者（1480 名接受 HFNC 治疗）。与 COT 相比，HFNC 降低了插管率（OR 0.44，95%CI 0.28 至 0.71，p=0.0007），降低了 28 天 ICU 死亡率（OR 0.54，95%CI 0.30 至 0.97，p=0.04），并提高了 28 天 VFDs（平均差值（MD）2.58，95%CI 1.70 至 3.45，p<0.00001）。然而，HFNC 对 ICU LOS 与 COT 相比没有影响（MD 0.52，95%CI -1.01 至 2.06，p=0.50）。

结论

本研究表明，与 COT 相比，HFNC 可能降低 COVID-19 相关 ARF 患者的插管率和 28 天 ICU 死亡率，并提高 28 天 VFDs。需要大规模的随机对照试验来验证我们的发现。

PROSPERO 注册号：CRD42022345713。