Background
Methods
Search strategy
Study selection
Data extraction and quality assessment
Outcome measures
Statistical analysis
Results
Study selection and characteristics
Study | Year | Region | Disease | Sample(n) | Sex (male/female) | Age (\(\overline{x }\)±s, years) | Intervention | Grade (risk of bias) | Included outcomes | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HFNC | NIV | HFNC | NIV | HFNC | NIV | HFNC | NIV | ||||||
Hernández et al | 2016 | France | High-risk patients | 290 | 314 | 186/104 | 202/112 | 64.6 ± 15.4 | 64.4 ± 15.8 | 37℃, 10L/min, 5L/min was increased until the patient felt unwell | IPAP and EPAP were adjusted to target a Rr of 25/ min and adequate gas exchange | A | (1)(2)(3)(4)(5)(6) |
Hu et al | 2018 | China | AECOPD | 60 | 60 | 34/26 | 30/30 | NA | NA | 37℃, 40L/min, keep SpO2 > 92% | IPAP 10–12 cm H2O, EPAP 4–6 cmH2O | B | (1)(4)(5)(7) |
Jiang et al | 2019 | China | AECOPD | 18 | 17 | 13/5 | 11/6 | 75.0 ± 5.1 | 71.0 ± 6.5 | 50L/min, keep SpO2 > 92% | 5–8cmH2O EPAP, keep SpO2 > 92% | B | (1)(3)(4)(5)(7) |
Jing et al | 2019 | China | COPD | 22 | 20 | NA | NA | 77.4 ± 6.8 | 73.9 ± 6.9 | 37℃, keep SpO2 88%–92% | IPAP 10–12 cmH2O, EPAP 4–5cmH2O | A | (1)(2)(3)(4)(5)(6)(7) |
Liu et al | 2019 | China | COPD | 44 | 43 | 24/20 | 22/21 | 64.1 ± 10.5 | 65.1 ± 9.7 | 20–40 L/min | IPAP 4 cmH2O, 5–10 min increased 2 cmH2O, keep 8–20cmH2O, EPAP 4–6cmH2O | B | (1)(2)(5)(7) |
Shang et al | 2021 | China | APACHEII > 12 | 24 | 24 | 12/12 | 13/11 | 66.92 ± 4.58 | 67.7 ± 6.89 | 37℃, 40L/min, keep SpO2 > 90% | 10–12cmH2O IPAP, 4–6cmH2O EPAP | B | (1)(2)(3)(4)(5)(7) |
Tan et al | 2020 | China | COPD | 44 | 42 | 27/17 | 24/19 | 68.4 ± 9.3 | 71.4 ± 7.8 | 37℃, 50L/min, keep SpO2 88%–92% | 8cmH2O IPAP, 4cmH2O EPAP | A | (1)(2)(3)(4)(5)(6)(7) |
Tongyoo et al | 2021 | Thai-land | > 65 | 60 | 58 | NA | NA | > 65 | > 65 | 37℃, 30L/min, 10 min increased 5L/min until 50L/min | 8cmH2O IPAP, 5cmH2O EPAP, IPAP increased 2cmH2O per 10 min | A | (1) |
Wang et al | 2021 | China | SAP with ARDS | 30 | 30 | 25/5 | 24/6 | 43 ± 7 | 41 ± 7 | 37℃, 40–50L/min, keep SpO2 > 95% | IPAP 5–12cmH2O, EPAP 0–5cmH2O | B | (1)(2)(3)(4)(5)(6)(7) |
Xu et al | 2021 | China | COPD | 50 | 50 | 32/18 | 30/20 | 69.2 ± 6.13 | 68.3 ± 5.22 | 37℃, FiO2 30%–50%, 50 L/min, keep SpO2 88%–92% | EPAP 4–5mmH2O, IPAP 10–12mmH2O, keep SpO2 88%-92% | B | (1)(4) |
Yang et al | 2015 | China | Post- cardiac surgery | 20 | 20 | 14/6 | 13/2 | 53.8 ± 8.9 | 52.9 ± 7.8 | 37℃, 45 L/min | IPAP 10–12cmH2O, EPAP 4–6 cmH2O | B | (1)(2)(3)(4)(5)(6)(7) |
Yu et al | 2019 | China | COPD | 36 | 36 | 24/12 | 21/15 | 62.4 ± 10.1 | 63.5 ± 11.2 | 37℃, 30–60 L/min, FiO2 30%–80% | IPAP 10–14 cmH2O, EPAP 4–6 cmH2O | B | (1)(2)(4)(5)(6)(7) |
Zhang et al | 2018 | China | COPD | 21 | 24 | 18/3 | 20/4 | 64.5 ± 5.3 | 66.1 ± 6.6 | 37℃, 40L/min, when SpO2 = 92%, change 30L/min | IPAP 5–15 cmH2O, EPAP 0–5cmH2O | B | (1)(2)(3)(4)(5)(6) |
Efficacy of HFNC
Reintubation
Mortality
ICU length of stay
Incidence of adverse events
Respiratory function-related indices
Subgroup analysis
Sensitivity analysis
Outcome | Before sensitivity analysis | Remove study | After sensitivity analysis | ||||
---|---|---|---|---|---|---|---|
Effect estimate | P | I2 (%) | Effect estimate | P | I2 (%) | ||
PaCO2 | − 1.31(− 2.76, 0.13) | 0.07 | 81 | Yang et al. 2016 | − 0.63(− 1.46, -0.20) | 0.14 | 40 |
PaO2/ FiO2 | − 2.18(− 8.49, 4.13) | 0.50 | 57 | Yang et al. 2016 | 1.21(− 3.29, 5.71) | 0.60 | 21 |
RR | − 0.50(− 1.88, 0.88) | 0.47 | 80 | Yang et al. 2016 | − 0.13(− 0.85, 1.11) | 0.80 | 57 |
Assessment of publication bias
Certainty assessment
Outcomes | Number of studies | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Relative risk | Absolute effect | GRADE |
---|---|---|---|---|---|---|---|---|---|
Reintubation | 13 | No | No | No | No | Undetected | 1.10 (0.87–1.40) | 15/1000 (− 19–59) | ⨁⨁⨁⨁ High |
Mortality | 9 | No | No | No | Serious | Undetected | 1.09 (0.82–1.46) | 12/1000 (− 24–62) | ⨁⨁⨁◯ Moderate |
ICU stay | 9 | No | Seriousa | No | Serious | Undetected | – | − 1.03 (− 1.86–− 0.2) | ⨁⨁◯◯ Low |
Abdominal distension | 5 | Seriousb | No | No | No | Undetected | 0.09 (0.04–0.24) | − 267/1000 (− 281–− 223) | ⨁⨁⨁◯ Moderate |
Aspiration | 4 | Seriousb | No | No | No | Undetected | 0.30 (0.09–1.07) | − 63/1000 (− 82–6) | ⨁⨁⨁◯ Moderate |
Facial injury | 5 | No | No | No | No | Undetected | 0.27 (0.09–0.88) | − 52/1000 (− 65–− 9) | ⨁⨁⨁⨁ High |
Intolerance | 3 | Seriousb | No | No | No | Strongly suspectedc | 0.22 (0.08–0.57) | − 214/1000 (− 252–− 118) | ⨁⨁◯◯ Low |
Pulmonary complications | 3 | No | No | No | No | Strongly suspectedc | 0.67 (0.46–0.99) | − 41/1000 (− 67–− 1) | ⨁⨁⨁◯ Moderate |
Delirium | 2 | Seriousd | No | No | No | Strongly suspectedc | 0.30 (0.07–1.39) | − 91/1000 (− 121–51) | ⨁⨁◯◯ Low |
Partial pressure of carbon dioxide | 11 | No | Seriouse | No | No | Strongly suspectedf | – | − 1.31 (− 2.76–0.13) | ⨁⨁◯◯ Low |
Oxygenation
index | 8 | No | No | No | Serious | Undetected | – | − 2.18 (− 8.49–4.13) | ⨁⨁⨁◯ Moderate |
Respiratory rate | 9 | No | Seriousa | No | Serious | Undetected | – | − 0.5 (− 1.88–0.88) | ⨁⨁◯◯ Low |