College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
PLoS One. 2024 Apr 3;19(4):e0299693. doi: 10.1371/journal.pone.0299693. eCollection 2024.
Mechanical ventilation is commonly used for managing respiratory failure in chronic obstructive pulmonary disease (COPD) patients, but weaning patients off ventilator support can be challenging and associated with complications. While many patients respond well to Non-invasive ventilation (NIV), a significant proportion may not respond as favourably. We aimed to assess whether high-flow nasal cannula (HFNC) is equally effective as NIV in reducing extubation failure among previously intubated COPD patients.
This systematic review was carried out in line with PRISMA guidelines We searched PubMed, Scopus, Web of Science, and Cochrane library from inception until February 15, 2023. Randomized Clinical Trials (RCTs) of adults at high risk for extubating failure were included. We examined the use of HFNC as the intervention and NIV as the comparator. Our outcome of interest included, reintubation rate, length of hospital or intensive care unit (ICU) stay, adverse events, and time to reintubation. The Cochrane risk-of-bias tool was used for randomized trials to assess risk of bias.
We identified 348 citations, 11 of which were included, representing 2,666 patients. The trials indicate that HFNC is comparable to NIV in preventing reintubation after extubating in COPD patients. In comparison to NIV, HFNC also produced improved tolerance, comfort, and less complications such as airway care interventions. NIV with active humification may be more effective that HFNC in avoiding reintubation in patients who are at extremely high risk for extubating failure.
The inconclusive nature of emerging evidence highlights the need for additional studies to establish the efficacy and suitability of HFNC as an alternative to NIV for previously intubated COPD patients. Clinicians should consider the available options and individualize their approach based on patient characteristics. Future research should focus on addressing these gaps in knowledge to guide clinical decision-making and optimize outcomes for this patient population.
机械通气常用于治疗慢性阻塞性肺疾病（COPD）患者的呼吸衰竭，但患者脱机可能具有挑战性，并伴有并发症。虽然许多患者对无创通气（NIV）反应良好，但仍有相当一部分患者反应不佳。我们旨在评估高流量鼻导管（HFNC）是否与 NIV 同样有效地降低先前插管 COPD 患者的拔管失败率。
本系统评价按照 PRISMA 指南进行，我们检索了 PubMed、Scopus、Web of Science 和 Cochrane 图书馆，从成立到 2023 年 2 月 15 日。纳入了高拔管失败风险的成人的随机临床试验（RCT）。我们研究了 HFNC 的使用作为干预措施和 NIV 作为比较。我们感兴趣的结果包括再插管率、住院或重症监护病房（ICU）停留时间、不良事件和再插管时间。使用 Cochrane 偏倚风险工具对随机试验进行评估。
我们共确定了 348 篇引文，其中 11 篇被纳入，代表了 2666 名患者。这些试验表明，HFNC 与 NIV 预防 COPD 患者拔管后再插管的效果相当。与 NIV 相比，HFNC 还提高了耐受性、舒适度，并减少了气道护理干预等并发症。在拔管失败风险极高的患者中，带主动湿化的 NIV 可能比 HFNC 更有效地避免再插管。
新兴证据的不确定性强调需要进一步研究，以确定 HFNC 作为替代 NIV 治疗先前插管 COPD 患者的疗效和适用性。临床医生应根据患者的特点考虑可用的选择，并根据患者的特点进行个体化治疗。未来的研究应重点解决这些知识空白，以指导临床决策并优化这一患者群体的结局。
