Non-invasive ventilation strategy for patients with acute respiratory failure in emergency department – a systematic review

Abstract

Background: We sought to assess the efficacy of noninvasive positive pressure ventilation against high-flow nasal cannula in patients experiencing acute respiratory failure, as they may be necessary if the respiratory insufficiency is more severe. Method: We conducted a thorough search from 2013 to 2023 throughout EMBASE, Cochrane library, MEDLINE, and CINAHL database. We incorporated randomized control trials that contrasted adult patients with ARF with HFNC and NIPPV. We collected data on trial features, demographics, intervention and control arm management, and clinical outcome outcomes of interest. For the economic outcomes, we collected data on the analytical approach, research design, time horizon, study viewpoint, and study features. Results: We included 6 RCTs with a total of 1421 patients after evaluating 612 citations. Patients in RCTs ranged in number from 30 to 791. Of the six RCTs, one was published after being abstracted. Overall, HFNC was compared to facemask NIPPV in five investigations, and to both facemasks in one research. Patients with hypoxic respiratory failure caused by the corona virus were included in two investigations, along with those with mixed hypoxia respiratory failure, immunocompromised patients by themselves, and one study with mixed respiratory failure. Conclusion: While there is conflicting evidence about the impact of HFNC and NIPPV on mortality in hospitalized patients with hypoxemic respiratory failure, they may be equally successful in lowering the requirement for intubation.