scholarly journals The Use of High Flow Nasal Oxygen and Its Effects on Reintubation When Compared to Non-Invasive Ventilation a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
W. Khokher ◽  
N. Kesireddy ◽  
P.H. Mudiyanselage ◽  
S. Iftikhar ◽  
S. Ghazaleh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
High Flow ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Helmet non-invasive ventilation compared to facemask non-invasive ventilation and high flow nasal cannula in acute respiratory failure: a systematic review and meta-analysis

2021 ◽  
pp. 2101269
Author(s):  
Dipayan Chaudhuri ◽  
Rehman Jinah ◽  
Karen E.A. Burns ◽  
Federico Angriman ◽  
Bruno Ferreyro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Observational Studies ◽  
Meta Analysis ◽  
High Flow ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Icu Length Of Stay ◽  
Non Invasive Ventilation

BackgroundAlthough small randomised controlled trials (RCTs) and observational studies have examined helmet non-invasive ventilation (NIV), uncertainty remains regarding its role. We conducted a systematic review and meta-analysis to examine the effect of helmet NIV compared to facemask NIV or high flow nasal cannula (HFNC) in acute respiratory failure.MethodsWe searched multiple databases to identify RCTs and observational studies reporting on at least one of mortality, intubation, ICU length of stay, NIV duration, complications, or comfort with NIV therapy. We assessed study risk of bias (ROB) using the Cochrane ROB tool for RCTs and the Ottawa-Newcastle scale for observational studies and rated certainty of pooled evidence using GRADE.ResultsWe separately pooled data from 16 RCTs (n=949) and 8 observational studies (n=396). Compared to facemask NIV, based on low certainty evidence, helmet NIV may reduce mortality (relative risk (RR) 0.56, 95% confidence interval (CI) (0.33 to 0.95)), and intubation (RR 0.35, 95% CI (0.22 to 0.56)) in both hypoxic and hypercapnic respiratory failure but may have no effect on duration of NIV. There was an uncertain effect of helmet on ICU length of stay and development of pressure sores. Data from observational studies was consistent with the foregoing findings but of lower certainty. Based on low and very low certainty data, helmet NIV may reduce intubation compared to HFNC, but its effect on mortality is uncertain.ConclusionCompared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet compared to HFNC remains uncertain.

scholarly journals High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

2020 ◽  
Author(s):  
Asem Alnajada ◽  
Bronagh Blackwood ◽  
Abdulmajeed Almobrad ◽  
Adeel Akhtar ◽  
Murali Shyamsundar
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Meta Analysis ◽  
High Flow ◽  
Current Evidence ◽  
Acute Type ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract BackgroundAcute Type 2 respiratory failure (AT2RF) is defined by hypercapnia (>6kPa) and these patients require ventilatory support in a significant proportion of cases. Non-invasive ventilation (NIV) is effective in preventing escalation to invasive mechanical ventilation (IMV) but has a high failure rate. High flow nasal oxygen (HFNO) is a novel device that integrates humidified air with oxygen at flow rates of up to 60 L/min. Various additional benefits including carbon-di-oxide (CO2) clearance have been attributed to HFNO. This systematic review aims to determine whether the use of HFNO for patients with AT2RF 1) improves arterial CO2 (PaCO2), 2) improves other clinical and patient-centred outcomes and 3) assess any potential harms.MethodSearches for relevant studies will be conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials, with no language restrictions. In addition, we will search Google Scholar and the references of all articles for any pertinent studies not found in our initial search. With the assistance of a professional librarian, we will develop a systematic search strategy using appropriate keywords and MeSH terms. We will identify trials that examined the efficacy of HFNO in adult AT2RF patients. We will include randomised trials and observational studies that compared two or more modalities of oxygen delivery that includes high flow nasal oxygen as one of the modes with the comparator being low flow oxygen and/or non-invasive ventilation. The primary outcome is change in PaCO2 level while other clinical and patient centred outcomes will be collected. Two reviewers will independently assess studies for eligibility, data extraction and quality appraisal. We will conduct a meta-analysis and/or a narrative summary as appropriate.DiscussionHFNO is utilised extensively in clinical practice with widening indications of use. The effects of HFNO includes CO2 clearance and PEEP benefits that may be beneficial to patients with AT2RF. While current publications indicate a beneficial role, no systematic review has attempted to summarise the evidence for this indication. The results of the proposed systematic review will summarise the current evidence to guide practice, guideline development and the design of future trials.Systematic review registrationPROSPERO CRD42019148748. (https://www.crd.york.ac.uk/prospero/)

scholarly journals Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039655
Author(s):  
Christopher Gerdung ◽  
Sara Rodriguez-Lopez ◽  
Stefan Palkowski ◽  
Diana Keto-Lambert ◽  
Meghan Sebastianski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Invasive Ventilation ◽  
Metabolic Markers ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Obstructive Sleep

IntroductionObstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA.Methods and analysisA systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed.Ethics and disseminationThere are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.

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