Shallik Nabil, Bashir Khalid, Elmoheen Amr, Iftikhar Haris, Zaki Hany A
Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar.
Clinical Anaesthesia Department, Weill Cornell Medical College in Qatar, Doha, Qatar.
Trends Anaesth Crit Care. 2023 Jun;50:101238. doi: 10.1016/j.tacc.2023.101238. Epub 2023 Apr 18.
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, which was first discovered in Wuhan, China. The disease has grown into a global pandemic causing mild to moderate symptoms in most people. The disease can also exhibit serious illnesses, especially for patients with other chronic diseases such as cardiovascular diseases, diabetes, chronic respiratory disease, or cancer. In such cases of severe illness, high flow nasal oxygen (HFNO) has been used to provide oxygenation to COVID-19 patients. However, the efficiency of HFNO remains uncertain, prompting the conduction of this systematic review to evaluate the effectiveness of the therapy. A thorough search for relevant and original articles was carried out on five electronic databases, including ScienceDirect, PubMed, Cochrane Library, Embase, and Google Scholar. No time limitation was placed during the search as it included all the articles related to COVID-19 from 2019 to 2022. The search strategy utilized in this systematic review yielded 504 articles, of which only 10 met the eligibility criteria and were included. Our meta-analysis reveals that HFNO success rate was higher than HFNO failure rates (0.52 (95% CI; 0.47, 0.56) and 0.48 (95% CI; 0.44, 0.53), respectively), however, the difference was statistically insignificant. HFNO was associated with a significant decrease in mortality and intubation rates (0.28 (95% CI; 0.19, 0.39) and 0.28 (95% CI; 0.18, 0.41), respectively). Our statistical analysis has shown that significantly lower ROX index (5.07 ± 1.66, p = 0.028) and PaO/FiO (100 ± 27.51, p = 0.031) are associated with HFNO failure, while a significantly lower respiratory rate (RR) (23.17 ± 4.167, p = 0.006) is associated with HFNO success. No statistically significant difference was observed in SpO/FiO ratio between the HFNO success and failure groups (154.23 ± 42.74 vs. 124.025 ± 28.50, p = 0.62, respectively). Based on the results from our meta-analysis, the success or failure of HFNO in treating COVID-19 adult patients remains uncertain. However, HFNO has been shown to be an effective treatment in reducing mortality and intubation rates. Therefore, HFNO can be recommended for COVID-19 patients but with close monitoring and should be carried out by experienced healthcare workers.
2019冠状病毒病（COVID-19）是一种由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的传染病，该病毒最早在中国武汉被发现。这种疾病已演变成一场全球大流行，大多数人表现出轻至中度症状。该疾病也可能出现严重病症，尤其是对于患有其他慢性疾病的患者，如心血管疾病、糖尿病、慢性呼吸系统疾病或癌症患者。在这些重症病例中，高流量鼻导管给氧（HFNO）已被用于为COVID-19患者提供氧疗。然而，HFNO的有效性仍不确定，因此开展了这项系统评价以评估该治疗方法的有效性。我们在五个电子数据库中进行了全面搜索，查找相关的原始文章，这些数据库包括ScienceDirect、PubMed、Cochrane图书馆、Embase和谷歌学术。搜索过程中未设置时间限制，因为其涵盖了2019年至2022年所有与COVID-19相关的文章。本系统评价所采用的搜索策略共检索到504篇文章，其中只有10篇符合纳入标准并被纳入。我们的荟萃分析显示，HFNO的成功率高于失败率（分别为0.52（95%置信区间；0.47，0.56）和0.48（95%置信区间；0.44，0.53）），然而，差异无统计学意义。HFNO与死亡率和插管率的显著降低相关（分别为0.28（95%置信区间；0.19，0.39）和0.28（95%置信区间；0.18，0.41））。我们的统计分析表明，显著更低的ROX指数（5.07 ± 1.66，p = 0.028）和动脉血氧分压/吸入氧分数值（PaO/FiO）（100 ± 27.51，p = 0.031）与HFNO失败相关，而显著更低的呼吸频率（RR）（23.17 ± 4.167，p = 0.006）与HFNO成功相关。HFNO成功组和失败组之间的血氧饱和度/吸入氧分数值（SpO/FiO）比值未观察到统计学显著差异（分别为154.23 ± 42.74和124.025 ± 28.50，p = 0.62）。基于我们荟萃分析的结果，HFNO治疗COVID-19成年患者的成功或失败仍不确定。然而，HFNO已被证明是一种降低死亡率和插管率的有效治疗方法。因此，HFNO可推荐用于COVID-19患者，但需密切监测，且应由经验丰富的医护人员实施。
