Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Pulmonary and Critical Care Department, Bumrungrad International Hospital, Khet Watthana, Bangkok, 10110, Thailand.
Sci Rep. 2023 May 22;13(1):8283. doi: 10.1038/s41598-023-35323-0.
The clinical benefits of noninvasive ventilation (NIV) for patients with acute hypoxemic respiratory failure (AHRF) is still inconclusive. We aimed to evaluate the effect of NIV compared with conventional oxygen therapy (COT)/high-flow nasal cannula (HFNC) in this patient population. We searched for relevant studies from PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CINHAL, Web of Science up to August 2019 for randomized controlled trials (RCTs) that compared NIV with COT/HFNC in AHRF. The primary outcome was the tracheal intubation rate. Secondary outcomes were intensive care unit (ICU) mortality, and hospital mortality. We applied the GRADE approach to grade the strength of the evidence. Seventeen RCTs that recruited 1738 patients were included in our meta-analysis. When comparing NIV versus COT/HFNC, the pooled risk ratio (RR) for the tracheal intubation rate was 0.68, 95% confidence interval (CI) 0.52-0.89, p = 0.005, I = 72.4%, low certainty of evidence. There were no significant differences in ICU mortality (pooled RR = 0.87, 95% CI 0.60-1.26), p = 0.45, I = 64.6%) and hospital mortality (pooled RR = 0.71, 95% CI 0.51-1.00, p = 0.05, I = 27.4%). Subgroup analysis revealed that NIV application with helmet was significantly associated with a lower intubation rate than NIV with face mask. NIV did not show a significant reduction in intubation rate compared to HFNC. In conclusion, NIV application in patients with medical illness and AHRF was associated with a lower risk of tracheal intubation compared to COT. NIV with helmet and HFNC are promising strategies to avoid tracheal intubation in this patient population and warrant further studies. NIV application had no effect on mortality.The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087342).
无创通气（NIV）治疗急性低氧性呼吸衰竭（AHRF）患者的临床获益尚不确定。我们旨在评估与常规氧疗（COT）/高流量鼻导管（HFNC）相比，NIV 在该患者人群中的效果。我们从 PubMed、Embase、Cochrane 图书馆、ClinicalTrials.gov、CINHAL、Web of Science 中搜索了截至 2019 年 8 月的相关研究，这些研究比较了 NIV 与 AHRF 中的 COT/HFNC。主要结局是气管插管率。次要结局是 ICU 死亡率和医院死亡率。我们应用 GRADE 方法对证据强度进行分级。纳入了 17 项随机对照试验（RCT），共纳入 1738 名患者。与 COT/HFNC 相比，NIV 组气管插管率的合并风险比（RR）为 0.68，95%置信区间（CI）为 0.52-0.89，p=0.005，I=72.4%，证据质量低。两组 ICU 死亡率（合并 RR=0.87，95%CI 0.60-1.26）、p=0.45，I=64.6%）和医院死亡率（合并 RR=0.71，95%CI 0.51-1.00，p=0.05，I=27.4%）均无显著差异。亚组分析显示，与 NIV 面罩相比，NIV 头盔的应用与较低的插管率显著相关。与 HFNC 相比，NIV 并未显著降低插管率。总之，与 COT 相比，NIV 应用于患有内科疾病和 AHRF 的患者与较低的气管插管风险相关。NIV 头盔和 HFNC 是避免该患者人群气管插管的有前途的策略，需要进一步研究。NIV 应用对死亡率没有影响。研究方案已在国际前瞻性系统评价注册库（PROSPERO；CRD42018087342）中注册。
