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首页> 外文期刊>Critical care : >High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis
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High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis

机译：高流量鼻插管氧疗优于常规氧疗，但插管率优于无创机械通气：系统评价和荟萃分析

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BackgroundHigh-flow nasal cannula oxygen (HFNC) is a relatively new therapy used in adults with respiratory failure. Whether it is superior to conventional oxygen therapy (COT) or to noninvasive mechanical ventilation (NIV) remains unclear. The aim of the present study was to investigate whether HFNC was superior to either COT or NIV in adult acute respiratory failure patients. MethodsA review of the literature was conducted from the electronic databases from inception up to 20 October 2016. Only randomized clinical trials comparing HFNC with COT or HFNC with NIV were included. The intubation rate was the primary outcome; secondary outcomes included the mechanical ventilation rate, the rate of escalation of respiratory support and mortality. ResultsEleven studies that enrolled 3459 patients (HFNC, n =?1681) were included. There were eight studies comparing HFNC with COT, two comparing HFNC with NIV, and one comparing all three. HFNC was associated with a significant reduction in intubation rate (OR 0.52, 95% CI 0.34 to 0.79, P =?0.002), mechanical ventilation rate (OR 0.56, 95% CI 0.33 to 0.97, P =?0.04) and the rate of escalation of respiratory support (OR 0.45, 95% CI 0.31 to 0.67, P P =?0.96). When HFNC was compared to NIV, there was no difference in the intubation rate (OR 0.96; 95% CI 0.66 to 1.39, P =?0.84), the rate of escalation of respiratory support (OR 1.00, 95% CI 0.77 to 1.28, P =?0.97) or mortality (OR 0.85, 95% CI 0.43 to 1.68, P =?0.65). ConclusionsCompared to COT, HFNC reduced the rate of intubation, mechanical ventilation and the escalation of respiratory support. When compared to NIV, HFNC showed no better outcomes. Large-scale randomized controlled trials are necessary to prove our findings. Trial registrationPROSPERO International prospective register of systematic reviews on May 25, 2016 registration no. CRD42016039581 .
机译：背景高流量鼻插管氧气（HFNC）是一种用于成人呼吸衰竭的相对较新的疗法。是否优于传统的氧气疗法（COT）还是优于无创机械通气（NIV）尚不清楚。本研究的目的是调查在成人急性呼吸衰竭患者中，HFNC是否优于COT或NIV。方法从开始到2016年10月20日，通过电子数据库对文献进行回顾。仅包括比较HFNC与COT或HFNC与NIV的随机临床试验。插管率是主要结果。次要结局包括机械通气率，呼吸支持升级率和死亡率。结果纳入11项研究，纳入3459例患者（HFNC，n =？1681）。有八项研究将HFNC与COT进行了比较，两项研究将HFNC与NIV进行了比较，一项对所有三项进行了比较。 HFNC与插管率（OR 0.52，95％CI 0.34至0.79，P =？0.002），机械通气率（OR 0.56，95％CI 0.33至0.97，P =？0.04）显着降低有关。升级呼吸支持（OR 0.45，95％CI 0.31至0.67，PP =？0.96）。当将HFNC与NIV进行比较时，插管率没有差异（OR 0.96; 95％CI 0.66至1.39，P =？0.84）;呼吸支持率的升高率（OR 1.00，95％CI 0.77至1.28， P = 0.97）或死亡率（OR 0.85，95％CI 0.43至1.68，P = 0.65）。结论与COT相比，HFNC减少了插管，机械通气和呼吸支持的升级。与NIV相比，HFNC没有显示出更好的结果。大规模随机对照试验对于证明我们的发现是必要的。试用注册PROSPERO国际前瞻性注册系统评价于2016年5月25日注册。 CRD42016039581。

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