Chaudhuri Dipayan, Trivedi Vatsal, Lewis Kimberley, Rochwerg Bram
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Crit Care Explor. 2023 Mar 28;5(4):e0892. doi: 10.1097/CCE.0000000000000892. eCollection 2023 Apr.
To evaluate the efficacy and cost-effectiveness of high-flow nasal cannula (HFNC) when compared with noninvasive positive pressure ventilation (NIPPV) in patients with acute hypoxic respiratory failure (AHRF).
We performed a comprehensive search of MEDLINE, Embase, CINAHL, the Cochrane library, and the international Health Technology Assessment database from inception to September 14, 2022.
We included randomized control studies that compared HFNC to NIPPV in adult patients with AHRF. For clinical outcomes, we included only parallel group and crossover randomized control trials (RCTs). For economic outcomes, we included any study design that evaluated cost-effectiveness, cost-utility, or cost benefit analyses.
Clinical outcomes of interest included intubation, mortality, ICU and hospital length of stay (LOS), and patient-reported dyspnea. Economic outcomes of interest included costs, cost-effectiveness, and cost-utility.
We included nine RCTs ( = 1,539 patients) and one cost-effectiveness study. Compared with NIPPV, HFNC may have no effect on the need for intubation (relative risk [RR], 0.93; 95% CI, 0.69-1.27; low certainty) and an uncertain effect on mortality (RR, 0.84; 95% CI, 0.59-1.21; very low certainty). In subgroup analysis, NIPPV delivered through the helmet interface-as opposed to the facemask interface-may reduce intubation compared with HFNC ( = 0.006; moderate credibility of subgroup effect). There was no difference in ICU or hospital LOS (both low certainty) and an uncertain effect on patient-reported dyspnea (very low certainty). We could make no conclusions regarding the cost-effectiveness of HFNC compared with NIPPV.
HFNC and NIPPV may be similarly effective at reducing the need for intubation with an uncertain effect on mortality in hospitalized patients with hypoxemic respiratory failure. More research evaluating different interfaces in varying clinical contexts is needed to improve generalizability and precision of findings.
评估高流量鼻导管（HFNC）与无创正压通气（NIPPV）相比，在急性低氧性呼吸衰竭（AHRF）患者中的疗效和成本效益。
我们对MEDLINE、Embase、CINAHL、Cochrane图书馆以及国际卫生技术评估数据库进行了全面检索，检索时间从数据库创建至2022年9月14日。
我们纳入了将HFNC与NIPPV在成年AHRF患者中进行比较的随机对照研究。对于临床结局，我们仅纳入平行组和交叉随机对照试验（RCT）。对于经济结局，我们纳入了评估成本效益、成本效用或成本效益分析的任何研究设计。
感兴趣的临床结局包括插管、死亡率、重症监护病房（ICU）和医院住院时间（LOS）以及患者报告的呼吸困难。感兴趣的经济结局包括成本、成本效益和成本效用。
我们纳入了9项RCT（n = 1539例患者）和1项成本效益研究。与NIPPV相比，HFNC可能对插管需求无影响（相对风险[RR]，0.93；95%置信区间[CI]，0.69 - 1.27；低确定性），对死亡率的影响不确定（RR，0.84；95% CI，0.59 - 1.21；极低确定性）。在亚组分析中，与HFNC相比，通过头盔接口而非面罩接口进行的NIPPV可能会减少插管（P = 0.006；亚组效应的可信度中等）。ICU或医院LOS无差异（均为低确定性），对患者报告的呼吸困难影响不确定（极低确定性）。与NIPPV相比，我们无法得出关于HFNC成本效益的结论。
在低氧性呼吸衰竭住院患者中，HFNC和NIPPV在减少插管需求方面可能同样有效，但对死亡率的影响不确定。需要更多研究评估不同临床背景下的不同接口，以提高研究结果的普遍性和精确性。
