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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

15.06.2020 | COVID-19 | Review Article/Brief Review Zur Zeit gratis

High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission

verfasst von: Arnav Agarwal, MD, John Basmaji, MD, Fiona Muttalib, MD, David Granton, MD, Dipayan Chaudhuri, MD, Devin Chetan, MD, Malini Hu, BSc, Shannon M. Fernando, MD, Kimia Honarmand, MD, Layla Bakaa, OSSD, Sonia Brar, MD, Bram Rochwerg, MD, Neill K. Adhikari, MD, Francois Lamontagne, MD, Srinivas Murthy, MD, David S. C. Hui, MD, Charles Gomersall, MD, Samira Mubareka, MD, Janet V. Diaz, MD, Karen E. A. Burns, MD, Rachel Couban, MISt, Quazi Ibrahim, MSc, Gordon H. Guyatt, MD, Per O. Vandvik, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 9/2020

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Abstract

Purpose

We conducted two World Health Organization-commissioned reviews to inform use of high-flow nasal cannula (HFNC) in patients with coronavirus disease (COVID-19). We synthesized the evidence regarding efficacy and safety (review 1), as well as risks of droplet dispersion, aerosol generation, and associated transmission (review 2) of viral products.

Source

Literature searches were performed in Ovid MEDLINE, Embase, Web of Science, Chinese databases, and medRxiv. Review 1: we synthesized results from randomized-controlled trials (RCTs) comparing HFNC to conventional oxygen therapy (COT) in critically ill patients with acute hypoxemic respiratory failure. Review 2: we narratively summarized findings from studies evaluating droplet dispersion, aerosol generation, or infection transmission associated with HFNC. For both reviews, paired reviewers independently conducted screening, data extraction, and risk of bias assessment. We evaluated certainty of evidence using GRADE methodology.

Principal findings

No eligible studies included COVID-19 patients. Review 1: 12 RCTs (n = 1,989 patients) provided low-certainty evidence that HFNC may reduce invasive ventilation (relative risk [RR], 0.85; 95% confidence interval [CI], 0.74 to 0.99) and escalation of oxygen therapy (RR, 0.71; 95% CI, 0.51 to 0.98) in patients with respiratory failure. Results provided no support for differences in mortality (moderate certainty), or in-hospital or intensive care length of stay (moderate and low certainty, respectively). Review 2: four studies evaluating droplet dispersion and three evaluating aerosol generation and dispersion provided very low certainty evidence. Two simulation studies and a crossover study showed mixed findings regarding the effect of HFNC on droplet dispersion. Although two simulation studies reported no associated increase in aerosol dispersion, one reported that higher flow rates were associated with increased regions of aerosol density.

Conclusions

High-flow nasal cannula may reduce the need for invasive ventilation and escalation of therapy compared with COT in COVID-19 patients with acute hypoxemic respiratory failure. This benefit must be balanced against the unknown risk of airborne transmission.

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Titel: High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission
verfasst von: Arnav Agarwal, MD
John Basmaji, MD
Fiona Muttalib, MD
David Granton, MD
Dipayan Chaudhuri, MD
Devin Chetan, MD
Malini Hu, BSc
Shannon M. Fernando, MD
Kimia Honarmand, MD
Layla Bakaa, OSSD
Sonia Brar, MD
Bram Rochwerg, MD
Neill K. Adhikari, MD
Francois Lamontagne, MD
Srinivas Murthy, MD
David S. C. Hui, MD
Charles Gomersall, MD
Samira Mubareka, MD
Janet V. Diaz, MD
Karen E. A. Burns, MD
Rachel Couban, MISt
Quazi Ibrahim, MSc
Gordon H. Guyatt, MD
Per O. Vandvik, MD
Publikationsdatum: 15.06.2020
Verlag: Springer International Publishing
Schlagwort: COVID-19
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 9/2020
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-020-01740-2

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High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission