Abstract
Objective To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy (COT) or noninvasive ventilation (NIV) for the treatment of acute respiratory failure (ARF) in emergency departments (EDs). Method We comprehensively searched 3 databases (PubMed, EMBASE, and the Cochrane Library) for articles published from database inception to 12 July 2019. This study included only randomized controlled trials (RCTs) that were conducted in EDs and compared HFNC therapy with COT or NIV. The primary outcome was the intubation rate. The secondary outcomes were the mortality rate, intensive care unit (ICU) admission rate, ED discharge rate, need for escalation, length of ED stay, length of hospital stay, and patient dyspnea and comfort scores. Result Five RCTs (n = 775) were included. There was a decreasing trend regarding the application of HFNC therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% CI, 0.26–1.09; p=0.08; I2 = 0%). We found that compared with patients who underwent COT, those who underwent HFNC therapy had a reduced need for escalation (RR, 0.41; 95% CI, 0.22–0.78; p=0.006; I2 = 0%), reduced dyspnea scores (MD −0.82, 95% CI −1.45 to −0.18), and improved comfort (SMD −0.76 SD, 95% CI −1.01 to −0.51). Compared with the COT group, the HFNC therapy group had a similar mortality rate (RR, 1.25; 95% CI, 0.79–1.99; p=0.34; I2 = 0%), ICU admission rate (RR, 1.11; 95% CI, 0.58–2.12; p=0.76; I2 = 0%), ED discharge rate (RR, 1.04; 95% CI, 0.63–1.72; p=0.87; I2 = 0%), length of ED stay (MD 1.66, 95% CI −0.95 to 4.27), and hospital stay (MD 0.9, 95% CI −2.06 to 3.87). Conclusion Administering HFNC therapy in ARF patients in EDs might decrease the intubation rate compared with COT. In addition, it can decrease the need for escalation, decrease the patient's dyspnea level, and increase the patient's comfort level compared with COT.
Highlights
Acute respiratory failure (ARF) is a critical condition faced in emergency departments (EDs)
Five randomized controlled trials (RCTs) (n 775) were included. ere was a decreasing trend regarding the application of high-flow nasal cannula (HFNC) therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% confidence intervals (CIs), 0.26–1.09; p 0.08; I2 0%)
We found that compared with patients who underwent Conventional oxygen therapy (COT), those who underwent HFNC therapy had a reduced need for escalation (RR, 0.41; 95% CI, 0.22–0.78; p 0.006; I2 0%), reduced dyspnea scores (MD − 0.82, 95% CI − 1.45 to − 0.18), and improved comfort (SMD − 0.76 standard deviation (SD), 95% CI − 1.01 to − 0.51)
Summary
Acute respiratory failure (ARF) is a critical condition faced in emergency departments (EDs) It can result from many conditions, such as cardiogenic pulmonary edema, pneumonia, or acute exacerbation of chronic obstructive pulmonary disease and has a high mortality rate [1]. According to a previous report, the NIV failure rate in ARF patients ranges from 5% to 60%, depending on numerous factors [6] Another investigation revealed that up to 25% of chronic obstructive pulmonary disease acute exacerbation patients do not tolerate NIV for several reasons [7]. Many studies have shown clinical benefits associated with high-flow nasal cannula (HFNC) therapy in ARF patients [8], the oxygen support of preoxygenation [9], acute pulmonary edema [10], the maintenance of oxygenation during bronchoscopy [11], and the prevention of reintubation [12] because an HFNC can provide warmed, humidified, and up to 100% oxygen. Methods is study design followed the Cochrane Handbook for Systematic Reviews of Interventions guidelines [20] and Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) statements [21]
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