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01.12.2019 | Research | Ausgabe 1/2019 Open Access

Critical Care 1/2019

High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis

Zeitschrift:
Critical Care > Ausgabe 1/2019
Autoren:
Youfeng Zhu, Haiyan Yin, Rui Zhang, Xiaoling Ye, Jianrui Wei
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13054-019-2465-y) contains supplementary material, which is available to authorized users.
Youfeng Zhu and Haiyan Yin have equal contributions and are co-first authors.
A comment to this article is available online at https://​doi.​org/​10.​1186/​s13054-019-2606-3.

Abstract

Background

The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the benefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other outcomes.

Method

We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials (RCTs) and crossover studies were included. The main outcome was postextubation respiratory failure.

Results

Ten studies (seven RCTs and three crossover studies; HFNC group: 856 patients; Conventional oxygen therapy (COT) group: 852 patients) were included. Compared with COT, HFNC may significantly reduce postextubation respiratory failure (RR, 0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02) and respiratory rates (standardized mean differences (SMD), − 0.70; 95% CI, − 1.16, − 0.25; z = 3.03; P = 0.002) and increase PaO2 (SMD, 0.30; 95% CI, 0.04, 0.56; z = 2.23; P = 0.03). There were no significant differences in reintubation rate, length of ICU and hospital stay, comfort score, PaCO2, mortality in ICU and hospital, and severe adverse events between HFNC and COT group.

Conclusions

Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after planned extubation. Further large-scale, multicenter studies are needed to confirm our results.
Zusatzmaterial
Additional file 1: Table S1. Studies Excluded after Full-text Review. Table S2. Quality of the included RCT studies. Table S3. Sensitivity analysis of the outcomes. Figure S1. Risk of bias graph. Figure S2. Risk of bias summary. Figure S3. Subgroup analysis of postextubation respiratory failure between the HFNC group and COT group according to HFNC duration. Figure S4. Subgroup analysis of postextubation respiratory failure between the HFNC group and COT group according to HFNC flow. Figure S5. Subgroup analysis of postextubation respiratory failure between the HFNC group and COT group according to severity of patients. Figure S6. Subgroup analysis of postextubation respiratory failure between the HFNC group and COT group according to hypercapnic or not. Figure S7. Trial sequential analysis. Figure S8. Comparison of reintubation between the two groups. Figure S9. Comparison of length of ICU stay between the two groups. Figure S10. Comparison of length of hospital stay between the two groups. Figure S11. Comparison of comfort score between the two groups. Figure S12. Comparison of PaCO2 between the two groups. Figure S13. Comparison of ICU mortality between the two groups. Figure S14. Comparison of hospital mortality between the two groups. Figure S15. Funnel plot of comparison for postextubation respiratory failure between the two group. Figure S16. Funnel plot of comparison for PaO2. Figure S17. Funnel plot of comparison for respiratory rates. Figure S18. Funnel plot of comparison for reintubation. Figure S19. Funnel plot of comparison for length of ICU stay. Figure S20. Funnel plot of comparison for length of hospital stay. Figure S21. Funnel plot of comparison for comfort score. Figure S22. Funnel plot of comparison for PaCO2. Figure S23. Funnel plot of comparison for ICU mortality. Figure S24. Funnel plot of comparison for hospital mortality. (DOC 613 kb)
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