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首页> 外文期刊>Journal of Thoracic Disease >Effect of high-flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation for preventing reintubation: a Bayesian network meta-analysis and systematic review
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Effect of high-flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation for preventing reintubation: a Bayesian network meta-analysis and systematic review

机译：高流量鼻腔套管对常规氧气治疗和非侵入性通风的影响防止重新涂覆：贝叶斯网络元分析和系统审查

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Background: Adequate respiratory support can improve clinical outcomes in patients who are ready for weaning from a ventilator. We aimed to investigate the efficacy of respiratory methods in adults undergoing planned extubation using a Bayesian network meta-analysis. Methods: We searched PubMed, Embase, and ClinicalTrials.gov for unpublished and ongoing trials up to November 2019 for randomized controlled trials (RCTs) published in English that compared conventional oxygen therapy (COT), a high-flow nasal cannula (HFNC), and noninvasive ventilation (NIV) for post-extubation respiratory support. Screening of citations, study selection, data extraction, and assessment of risk were performed independently by two authors. The primary outcome was the reintubation rate. Results: Twenty-two studies (4,218 patients) were included in our meta-analysis. Extubated patients supported with NIV had a significantly lower incidence of reintubation than those supported with COT [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.42, 0.89]. However, there was no significant difference in the reintubation rate between the HFNC and NIV, and HFNC and COT groups (OR: 1.05, 95% CI: 0.60, 1.81; OR: 0.60, 95% CI: 0.33, 1.02, respectively). HFNC and NIV reduced the incidence of hospital-acquired pneumonia (HAP) (OR: 0.50, 95% CI: 0.25, 0.93; OR: 0.55, 95% CI: 0.27, 0.87, respectively) and post-extubation acute respiratory failure (ARF) (OR: 0.35, 95% CI: 0.14, 0.89; OR: 0.31, 95% CI: 0.14, 0.63, respectively) compared with COT. There was no significant difference in a decreased incidence of HAP (OR: 1.1, 95% CI: 0.56, 1.8) or post-extubation ARF (OR: 0.87, 95% CI: 0.33, 2.1) between NIV and HFNC. There were also no significant differences in improvements in other clinical outcomes, including intensive care unit (ICU) and hospital mortality and the length of stay (LOS) between NIV and HFNC. Conclusions: NIV reduces the reintubation rate in adult patients undergoing planned extubation compared with COT and HFNC.
机译：背景：充足的呼吸促进支持可以改善准备从呼吸机断奶的患者中的临床结果。我们旨在探讨使用贝叶斯网络荟萃分析进行计划拔管的成年人呼吸方法的疗效。方法：我们搜索了Pubmed，Embase和Clinicaltrials.gov，对于2019年11月，对于由英语发布的随机对照试验（RCT），常规氧气治疗（COT），一种高流量鼻腔插管（HFNC），和非催化呼吸促进支持的非侵入性通风（NIV）。引用引用，学习选择，数据提取和风险评估的筛选是由两位作者独立进行的。主要结果是重新孵化率。结果：我们的META分析中包含二十两项研究（4,218名患者）。延伸的患有NIV的患者的重新抑制的发生率显着降低了婴儿床（OR）：0.63,95％置信区间隔（CI）：0.42,0.89]的那些。然而，HFNC和NIV和HFNC和COT组之间的重新抑制率没有显着差异（或：1.05,95％CI：0.60,1.81;或：0.60,95％CI：0.33,1.02）。 HFNC和NIV降低了医院获得的肺炎（HAP）的发病率（或：0.50,95％：0.25,0.93;或：0.55,95％CI：0.27,0.87，分别）和后急性呼吸衰竭（ARF ）（或：0.35,95％CI：0.14,0.89;或：0.31,95％CI：0.14,0.63分别）与COT相比。 HAP发生率降低（或：1.1,95％：0.56,1.8）或NIV和HFNC之间的后拔射ARF（或：0.87,95％CI：0.33,2.1），没有显着差异。其他临床结果的改善也没有显着差异，包括重症监护单位（ICU）和医院死亡率以及NIV和HFNC之间的逗留时间（LOS）。结论：与COT和HFNC相比，NIV降低了经历计划拔管的成年患者的重新涂布率。

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