Original ContributionThe effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis
Section snippets
Background
Approximately 60% of the patients are reported to receive endotracheal intubation and mechanical ventilation (MV) when admitted to the intensive care unit (ICU) [1]. In spite of the complete respiratory support, the hospital mortality of invasive mechanical ventilation remains as high as 30.7% due to the potential adverse events such as barotrauma and ventilator-associated pneumonia [2], [3]. Thus, treatment to avoid or substitute the endotracheal intubation has important clinical values for
Search strategies
From 1946 to October 2016, a comprehensive computer search was conducted in Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trails (CENTRAL) and Information Sciences Institute (ISI) Web of Science using the keywords of “HFNC” or “high-flow nasal cannula” or “high-flow oxygen therapy” or “nasal high-flow oxygen therapy” and “NIPPV” or “non-invasive positive pressure ventilation” or “noninvasive positive pressure ventilation” or “non-invasive ventilation” or “noninvasive
Results
Initially 776 records were identified, of which 767 were extracted from electronic databases and 9 were extracted from reference lists review. (Fig. 1) By screening the titles and abstracts, 741 studies were discarded for duplication (n = 205), animal experiments (n = 157), non-adult patients (n = 330), and non-controlled studies (n = 49). We searched the full-text articles for the remaining 35 studies, and eventually 8 trials [13], [14], [15], [17], [18], [19], [20], [21] were enrolled in our final
Discussion
In our meta-analysis, we found that HFNC could reduce the need for endotracheal intubation and decrease ICU mortality in adult patients when used before MV compared with both of COT and NIPPV. However, it could not shorten the ICU LOS compared with COT and NIPPV.
In our meta-analysis, we found a significant lower need for endotracheal intubation in patients receiving HFNC compared with COT, which might result from the following mechanisms. First of all, adequate minute ventilation and sufficient
Conclusions
Compared both with COT and NIPPV, HFNC could reduce rate of endotracheal intubation and ICU mortality in patients when used before MV, in spite of no benefit in ICU LOS.
- APACHE
The Acute Physiologic and Chronic Health Evaluation
- ARDS
acute respiratory distress syndrome
- CENTRAL
Cochrane Central Register of Controlled Trails
- CI
confidence interval
- COT
conventional oxygen therapy
- FiO2
fraction of inspired oxygen
- HFNC
high flow nasal cannula
- ICU
intensive care unit
- ISI
Information Sciences Institute
- LOS
length of stay
Abbreviations
Acknowledgements
Guarantor
YN-N takes responsibility for the content of the manuscript, including the data and analysis.
Author contributions
Y-NN and JL designed the study and drafted the manuscript; He Yu and DL conducted the literature searching, data analysis and helped to revise the manuscript critically for important intellectual content; B-ML and Z-AL helped design the study and revise the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Funding
This study was partly supported by Sichuan Science and Technology Agency Grant (2014SZ0010) and the National Natural Science Foundation of China (81600057).
Other contributions
We thank Professor Dongtao Lin (College of Foreign Languages, Sichuan University), who is specialized in biomedical writing and editing, for copyediting this manuscript.
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2022, American Journal of Emergency MedicineCitation Excerpt :Subgroup analysis of patients with a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen [PaO2/FiO2] ≤200 mmHg found that intubation rates were lower for HFNC versus conventional oxygen or NIPPV (hazard ratio 2.07 and 2.57, respectively) [32]. A later meta-analysis found HFNC reduced intubation rates compared to NIPPV (OR 0.48, 95% CI 0.31–0.73), as well as ICU mortality (OR 0.36, 95% 0.20–0.63) [33]. A randomized controlled trial (RCT) of patients with PaO2/FiO2 < 200 and COVID-19 found those receiving HFNC were less likely to be intubated (34.3% vs. 51%) and more likely to experience clinical recovery in 28 days (77.8% vs. 71%) compared to those receiving conventional oxygen [34].
High-flow nasal cannula in children with asthma exacerbation: A review of current evidence
2021, Paediatric Respiratory ReviewsCitation Excerpt :In the past 2 decades, HFNC has been introduced and widely used in adults [34,35], children [36,37], and neonates [38–40]. Numerous studies have revealed the safety and benefits of HFNC in hypoxemic respiratory failure [41–44] as an alternative to noninvasive ventilation [45], in post-extubation care [46–51], in post-cardiothoracic surgery [52], in post-abdominal surgery [53], and in exercise training [54]. In the present review, we discuss HFNC and variations in HFNC use with a focus on its feasibility and current evidence of HFNC use in children with asthma exacerbations.
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These authors contributed equally to this work.