Abstract
BackgroundAcute respiratory failure (ARF) is a common and life-threatening medical emergency in patients admitted to the hospital. Currently, there is a lack of large-scale evidence on the use of high-flow nasal cannulas (HFNC) in patients with ARF. In this systematic review and meta-analysis, we evaluated whether there were differences between HFNC therapy and conventional oxygen therapy (COT) for treating patients with ARF.MethodsThe EMBASE, Medline, and Wanfang databases and the Cochrane Library were searched. Two investigators independently collected the data and assessed the quality of each study. Randomized controlled trials that compared HFNC therapy with COT in patients with ARF were included. RevMan 5.3 was used to conduct the meta-analysis.ResultsFour studies that involved 703 patients with ARF were included, with 371 patients in the HFNC group and 332 patients in the COT group. In the overall estimates, there were no significant differences between the HFNC and COT groups in the rates of escalation of respiratory support (RR, 0.68; 95% CI, 0.37, 1.27; z = 1.20, P = 0.23), intubation (RR, 0.74; 95% CI, 0.55, 1.00; z = 1.95, P = 0.05), mortality (RR, 0.82; 95% CI, 0.36, 1.88; z = 0.47, P = 0.64), or ICU transfer (RR, 1.09; 95% CI, 0.57, 2.09; z = 0.26, P = 0.79) during ARF treatment. However, the subgroup analysis showed that HFNC therapy may decrease the rate of escalation of respiratory support (RR, 0.71; 95% CI, 0.53, 0.97; z = 2.15, P = 0.03) and the intubation rate (RR, 0.71; 95% CI, 0.53, 0.97; z = 2.15, P = 0.03) when ARF patients were treated with HFNC therapy for ≥24 h compared with COT.ConclusionsHFNC therapy was similar to COT in ARF patients. The subgroup analysis showed that HFNC therapy may decrease the rate of escalation of respiratory support and the intubation rate when ARF patients were treated with HFNC for ≥24 h compared with COT. Further high-quality, large-scale studies are needed to confirm our results.
Highlights
Acute respiratory failure (ARF) is a common and life-threatening medical emergency in patients admitted to the hospital
The overall estimates of this meta-analysis showed that there were no significant differences between the high-flow nasal cannulas (HFNC) and conventional oxygen therapy (COT) groups in the rates of escalation of respiratory support (RR, 0.68; 95% confidence intervals (CIs), 0.37, 1.27; z = 1.20, P = 0.23), intubation (RR, 0.74; 95% CI, 0.55, 1.00; z = 1.95, P = 0.05), mortality
The present meta-analysis found no significant differences between HFNC therapy and COT for the treatment of adult ARF patients, it should be noted that there was significant heterogeneity between the Randomized controlled trials (RCTs) included in the present study, which may have affected our conclusions
Summary
Acute respiratory failure (ARF) is a common and life-threatening medical emergency in patients admitted to the hospital. In this systematic review and meta-analysis, we evaluated whether there were differences between HFNC therapy and conventional oxygen therapy (COT) for treating patients with ARF. Acute respiratory failure (ARF) is a common and lifethreatening medical emergency in patients admitted to hospitals [1]. It is caused by a variety of diseases, including heart failure, pneumonia, and exacerbations of chronic obstructive pulmonary disease. Unassisted oxygen therapy is called conventional oxygen therapy (COT) It is the main supportive treatment administered to patients with ARF and is usually delivered with nasal prongs or facemasks. Choosing an optimal oxygen therapy device is very important for reducing the rates of IMV and mortality while ensuring patients’ safety and comfort
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