scholarly journals Can high-flow nasal cannula reduce the risk of bronchopulmonary dysplasia compared with CPAP in preterm infants? A systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabrina de Jesus Brito ◽  
Sabrina Pinheiro Tsopanoglou ◽  
Endi Lanza Galvão ◽  
Franciele Angelo de Deus ◽  
Vanessa Pereira de Lima
Keyword(s):  
Clinical Trials ◽  
Bronchopulmonary Dysplasia ◽  
Ventilatory Support ◽  
High Flow ◽  
Nasal Cannula ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Air Leak ◽  
Nasal Injury ◽  
Air Leak Syndrome

Abstract Background Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects the premature lung, and to reduce its incidence has been used non-invasive ventilatory support, such as continuous positive airway (CPAP) and high-flow nasal cannula (HFNC). Thus, the objective of this review was to assess whether the use of high flow nasal cannula (HFNC) compared to continuous positive airway pressure (CPAP) decreases the risk of bronchopulmonary dysplasia (BPD) in premature newborns. Methods The protocol was registered (Prospero: CRD42019136631) and the search was conducted in the MEDLINE, PEDro, Cochrane Library, CINAHL, Embase, and LILACS databases, and in the clinical trials registries, until July 2020. We included randomized clinical trials comparing HFNC versus CPAP use in premature infants born at less than 37 weeks of gestational age. The main outcome measures were the development of BPD, air leak syndrome, and nasal injury. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool and the GRADE system was used to summarize the evidence recommendations. Meta-analyses were performed using software R. Results No difference was found between HFNC or CPAP for the risk of BPD (RR: 1.10; 95% CI: 0.90–1.34), air leak syndrome (RR: 1.06; 95% CI: 0.52–2.14), and nasal trauma (RR: 2.00; 95% CI: 0.64–6.25), with a very low level of evidence. Conclusion(s) The HFNC showed similar results when compared to CPAP in relation to the risk of BPD, air leak syndrome, and nasal injury. In the literature, no randomized clinical trial has been found with BPD as the primary outcome to support possible outcomes.

scholarly journals Nasogastric tube, a warning sign for high-flow nasal cannula failure in infants with bronchiolitis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Milena Siciliano Nascimento ◽  
Danielle E. R. Quinto ◽  
Gisele C. Z. Oliveira ◽  
Celso M. Rebello ◽  
Cristiane do Prado
Keyword(s):  
Hospital Admission ◽  
Nasogastric Tube ◽  
Ventilatory Support ◽  
Study Groups ◽  
High Flow ◽  
Nasal Cannula ◽  
Warning Sign ◽  
High Flow Nasal Cannula ◽  
Therapy Failure ◽  
Oral Nutrition

Abstract High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30–28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54–4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98–1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82–1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.

Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

2019 ◽  
Vol 35 (4) ◽  
pp. 298-306 ◽  
Author(s):  
Nigel Fleeman ◽  
Yenal Dundar ◽  
Prakesh S Shah ◽  
Ben NJ Shaw
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Primary Outcome ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Safe Alternative

AbstractBackgroundHeated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a systematic review and meta-analyses examining the efficacy and safety of HHHFNC compared with standard treatments for preterm infants. The primary outcome was the need for reintubation for preterm infants following mechanical ventilation (post-extubation analysis) or need for intubation for preterm infants not previously intubated (analysis of primary respiratory support)MethodsWe searched PubMed, MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of HHHFNC versus standard treatments. Meta-analysis was conducted using Review Manager 5.3.ResultsThe post-extubation analysis included ten RCTs (n = 1,201), and the analysis of primary respiratory support included ten RCTs (n = 1,676). There were no statistically significant differences for outcomes measuring efficacy, including the primary outcome. There were statistically significant differences favoring HHHFNC versus nasal cannula positive airway pressure (NCPAP) for air leak (post-extubation, risk ratio [RR] 0.29, 95 percent confidence interval [CI] 0.11 to 0.76, I2 = 0) and nasal trauma (post-extubation: 0.35, 95 percent CI 0.27 to 0.46, I2 = 5 percent; primary respiratory support: RR 0.52, 95 percent CI 0.37 to 0.74; I2 = 27 percent). Studies, particularly those of primary respiratory support, included very few preterm infants with gestational age (GA) <28 weeks.ConclusionsHHHFNC may offer an efficacious and safe alternative to NCPAP for some infants but evidence is lacking for preterm infants with GA ≤28 weeks.

scholarly journals High-Flow Nasal Cannula in Hypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Yongkang Huang ◽  
Wei Lei ◽  
Wenyu Zhang ◽  
Jian-an Huang
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Cohort Studies ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Cochrane Library ◽  
Intubation Rate ◽  
High Flow Nasal Cannula ◽  
Hypercapnic Respiratory Failure

Background. Although the efficacy and safety of high-flow nasal cannula (HFNC) in hypoxemic respiratory failure are widely recognized, it is yet unclear whether HFNC can effectively reduce the intubation rate and mortality in hypercapnic respiratory failure. We performed a systematic review and meta-analysis to assess the safety and efficiency of HFNC in these patients. Methods. A systematic search of PubMed, Embase, and Cochrane Library (CENTRAL) was carried out. Two reviewers independently screened all references according to the inclusion criteria. We used the Cochrane risk-of-bias tool and the Newcastle–Ottawa Quality Assessment Scale to assess the quality of randomized controlled trials (RCTs) and cohort studies, respectively. Data from eligible trials were extracted for the meta-analysis. Results. Eight studies with a total of 621 participants were included (six RCTs and two cohort studies). Our analysis showed that HFNC is noninferior to noninvasive ventilation (NIV) with respect to intubation rate in both RCTs (OR = 0.92, 95% CI: 0.45–1.88) and cohort studies (OR = 0.94, 95% CI: 0.55–1.62). Similarly, the analysis of cohort studies showed no difference in reducing mortality rates (OR = 0.96, 95% CI: 0.42–2.20). Based on RCTs, NIV seemed more effective in reducing mortality (OR = 1.33, 95% CI: 0.68–2.60), but the intertreatment difference was not statistically significant. Furthermore, no significant differences were found between HFNC and NIV relating to change of blood gas analysis or respiratory rate (MD = −0.75, 95% CI: −2.6 to 1.09). Likewise, no significant intergroup differences were found with regard to intensive care unit stay (SMD = −0.07, 95% CI: 0.26 to 0.11). Due to a physiological friendly interface and variation, HFNC showed a significant advantage over NIV in patients’ comfort and complication of therapy. Conclusion. Despite the limitations noted, HFNC may be an effective and safe alternative to prevent endotracheal intubation and mortality when NIV is unsuitable in mild-to-moderate hypercapnia. Further high-quality studies are needed to validate these findings.

scholarly journals The value of ROX index in predicting the outcome of high flow nasal cannula: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Zhen Junhai ◽  
Yan Jing ◽  
Gong Shijin ◽  
Cao BeiBei ◽  
Li Li
Keyword(s):  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Cochrane Library ◽  
Acquisition Time ◽  
High Flow Nasal Cannula ◽  
Diagnostic Score ◽  
Sensitivity Specificity

Abstract Background: High flow nasal cannula (HFNC) therapy is widely employed in acute hypoxemic respiratory failure (AHRF) patients. However, the techniques for predicting HFNC outcome remain scarce.Methods: PubMed, EMBASE, and Cochrane Library were searched until April 20, 2021. We included the studies that evaluated the potential predictive value of ROX (respiratory rate-oxygenation) index for HFNC outcome. This meta-analysis determined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic score, diagnostic odds ratio (DOR), and pooled area under the summary receiver operating characteristic (SROC) curve.Results: We assessed nine studies with 1933 patients, of which 745 patients experienced HFNC failure. This meta-analysis found that sensitivity, specificity, PLR, NLR, diagnostic score, and DOR of ROX index in predicting HFNC failure were 0.67 (95% CI 0.57-0.76), 0.72 (95% CI 0.65-0.78), 2.4 (95% CI 2.0-2.8), 0.46 (95% CI 0.37-0.58), 1.65(95% CI 1.37-1.93), and 5.0 (95% CI 4.0-7.0), respectively. In addition, SROC was 0.75 (95% CI 0.71-0.79). Besides, our subgroup analyses revealed that ROX index had higher sensitivity and specificity for predicting HFNC failure in COVID-19 patients from non-European countries, while the acquisition time of 6 h after receiving HFNC had a lower sensitivity and specificity when compared to other times.Conclusions: This study demonstrated that ROX index could function as a novel potential marker to identify patients with a higher risk of HFNC failure. However, the prediction efficiency was moderate, and additional research is required to determine the optimal cut-off value and propel acquisition time of ROX index in the future.

scholarly journals Efficacy and Safety of Heated humidified high-flow nasal cannula for Preventing Extubation Failure in Neonates: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Jia Liu ◽  
Hongyan Qiu ◽  
Baihua Zheng ◽  
Lu Jin ◽  
Jing Chen
Keyword(s):  
Meta Analysis ◽  
Extubation Failure ◽  
Incidence Rates ◽  
High Flow ◽  
Nasal Cannula ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
High Flow Nasal Cannula ◽  
Nasal Trauma

Abstract Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a meta-analysis examining the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (NCPAP) for infants. Methods: Literature searches were conducted using PubMed, Cochrane Library, OVID, Embase, Web of Science, Chinese Biomedical Literature, Weipu Journal, Wanfang, and CNKI databases up to December 2020. Only randomized controlled trials (RCTs) of HHHFNC versus NCPAP in preventing extubation failure for infants were included. Results: A total of 13 RCTs research literatures involving 2395 infants were included in the Meta-analysis. The meta-analysis showed the following results. (1) In terms of efficacy, there were no significant differences between two groups in the treatment failure rate (RR: 1.00, 95%CI: 0.73 to 1.36, P=0.99) and reintubation rate (RR: 0.86, 95%CI: 0.70 to 1.06, P=0.16). While in term of safety, HHHFNC had a significant advantage over NCPAP in reducing the incidence rates of nasal trauma (RR: 0.27, 95%CI: 0.13 to 0.56, P=0.0005) and frequent hemorrhoid (RR: 0.40, 95%CI: 0.23 to 0.70, P=0.001).(2) In terms of secondary outcome measures, there were no significant differences between two groups in hospital mortality rate and incidence rates of BPD, ROP, IVH and duration of reaching full enteral feeding(P>0.05). HHHFNC demonstrated lower incidence of NEC (RR: 0.65, 95%CI: 0.43 to 0.98, P=0.04) than NCPAP. Conclusion:this meta-analysis showed that HHHFNC appears to be similar to NCPAP in efficacy of preventing extubation failure in infants. It is associated with significantly lower odds of nasal trauma, frequent hemorrhoid and NEC.

scholarly journals Sampling Methods and Risk Stratification Regarding Environmental Contamination by SARS-CoV-2

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Marta Mendes ◽  
Ana Andrade Oliveira ◽  
Olga Pires ◽  
Fernando Branca ◽  
Maria Beirão ◽  
...  
Keyword(s):  
Environmental Contamination ◽  
Ventilatory Support ◽  
High Flow ◽  
Nasal Cannula ◽  
Surface Contamination ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Zones

Introduction: Transmission of COVID-19 through close contact and droplets is well established, but the influence of aerosol and surface contamination remains to be determined. Literature is scarce and inconsistent about the viable virus particles free-distance from infected patients, as well as about different swabbing methods for surface contamination evaluation. The aim of this study was to evaluate the most sensitive method for the assessment of surface contamination, classify the likelihood of environmental contamination in risk zones and compare the environmental contamination between oxygenation and ventilatory support.Material and Methods: Swabs from potentially contaminated surfaces in a COVID-19 ward, with patients treated with different types of oxygen and ventilatory support, were collected. Three types of swabs were compared in order to evaluate the most sensitive collection method. For risk zone categorization, areas were divided according to the distance from the patient.Results: Of the 63 swabs collected, 17 (27%) tested positive for the presence of SARS-CoV-2. The highest positivity rate was observed with the sterile premoistened swab with saline (n = 8; 38%), but without statistically significant differences. The highest number of positive samples were collected from the high-risk zones, specifically those located one meter from the patient (n = 13; 48%), with statistically significant differences. Only the rooms of patients supported with non-invasive ventilation or high-flow nasal cannula had evidence of bedroom contamination, with 45% and 27% of swab positivity, with statistically significant differences.Discussion: Our findings favour the premoistened swab without transport medium for surface contamination assessment, even though without statistical differences. A statistically significant trend supporting the division in risk zones, according to the distance from the patient, was also identified. The higher positivity rate from the non-invasive ventilation and high-flow nasal cannula bedrooms suggests a significant association between ventilatory strategies and surface contamination, probably due to higher particle dispersion.Conclusion: Our findings support the use of the sterile premoistened swab without preservation medium, the classification of risk areas considering the distance from the patient, and the variability of RNA dispersion between oxygenation and ventilatory support.

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