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.

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 The efficacy and safety of high-flow nasal cannula therapy in patients with COPD and type II respiratory failure: a meta-analysis and systematic review

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Zhiping Xu ◽  
Lingxia Zhu ◽  
Jingye Zhan ◽  
Lijun Liu
Keyword(s):  
Respiratory Failure ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
High Flow ◽  
Nasal Cannula ◽  
Clinical Settings ◽  
Type Ii ◽  
Efficacy And Safety ◽  
High Flow Nasal Cannula ◽  
Meta Analyses

Abstract Background High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have been used for the treatment of COPD and respiratory failure in clinical settings. We aimed to evaluate the efficacy and safety of HFNC therapy in patients with COPD and type II respiratory failure, to provide evidence to the clinical COPD management. Methods We searched Cochrane et al. databases up to Dec 31, 2020 for randomized controlled trials (RCTs) on the use of HFNC therapy in patients with COPD and type II respiratory failure. Two researchers independently screened the literature according to the inclusion and exclusion criteria, and evaluated the quality of the literature and extracted data. We used Revman5.3 software for statistical analysis of collected data. Results A total of 6 RCTs involving 525 COPD and type II respiratory failure patients. Meta-analyses indicated that compared with NIV, HFNC could significantly reduce PaCO2 level (MD = − 2.64, 95% CI (− 3.12 to − 2.15)), length of hospital stay ((MD = – 1.19, 95 CI (− 2.23 to − 0.05)), the incidence of nasal facial skin breakdown ((OR = 0.11, 95% CI (0.03–0.41)). And there were no significant differences between the two groups in PaO2 ((MD = 2.92, 95% CI (− 0.05 to 5.90)), incidence of tracheal intubation ((OR = 0.74, 95% CI (0.34–1.59)) and mortality (OR = 0.77, 95% CI (0.28–2.11)). Conclusions HFNC is more advantageous over NIV in the treatment of COPD and type II respiratory failure. Future studies with larger sample size and strict design are needed to further elucidate the role of HFNC in COPD and respiratory failure.

scholarly journals Effect of high-flow nasal cannula oxygen therapy compared with conventional oxygen therapy in postoperative patients: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027523 ◽  
Author(s):  
Zhonghua Lu ◽  
Wei Chang ◽  
Shan-Shan Meng ◽  
Xiwen Zhang ◽  
Jianfeng Xie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Oxygen Therapy ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Surgical Patients ◽  
Respiratory Support ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Number Of Patients

ObjectiveTo evaluate the effect of high-flow nasal cannula oxygen therapy (HFNC) versus conventional oxygen therapy (COT) on the reintubation rate, rate of escalation of respiratory support and clinical outcomes in postextubation adult surgical patients.DesignSystematic review and meta-analysis of published literature.Data sourcesPubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Index and Wan fang databases were searched up to August 2018.Eligibility criteriaStudies in postoperative adult surgical patients (≥18 years), receiving HFNC or COT applied immediately after extubation that reported reintubation, escalation of respiratory support, postoperative pulmonary complications (PPCs) and mortality were eligible for inclusion.Data extraction and synthesisThe following data were extracted from the included studies: first author’s name, year of publication, study population, country of origin, study design, number of patients, patients’ baseline characteristics and outcomes. Associations were evaluated using risk ratio (RR) and 95% CIs.ResultsThis meta-analysis included 10 studies (1327 patients). HFNC significantly reduced the reintubation rate (RR 0.38, 95% CI 0.23 to 0.61, p<0.0001) and rate of escalation of respiratory support (RR 0.43, 95% CI 0.26 to 0.73, p=0.002) in postextubation surgical patients compared with COT. There were no differences in the incidence of PPCs (RR 0.87, 95% CI 0.70 to 1.08, p=0.21) or mortality (RR 0.45, 95% CI 0.16 to 1.29, p=0.14).ConclusionHFNC is associated with a significantly lower reintubation rate and rate of escalation of respiratory support compared with COT in postextubation adult surgical patients, but there is no difference in the incidence of PPCs or mortality. More well-designed, large randomised controlled trials are needed to determine the subpopulation of patients who are most likely to benefit from HFNC therapy.

Heated Humidified High-Flow Nasal Cannula vs. Nasal Continuous Positive Airway Pressure for Post-extubation Respiratory Support in Preterm Infants: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Rameshwor Yengkhom ◽  
Pradeep Suryawanshi ◽  
Bhvya Gupta ◽  
Sujata Deshpande
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Preterm Infants ◽  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Nasal Trauma

Abstract Objective The objective of this study was to compare the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (nCPAP) for prevention of extubation failure in preterm infants. Methods Preterm infants (gestation ≥28 weeks) were randomized to HHHFNC or nCPAP after extubation. Primary outcome was extubation failure within 72 h of extubation. Results A total of 128 preterm infants were randomized to receive either HHHFNC (n = 63) or nCPAP (n = 65) after extubation. The primary outcome of extubation failure within 72 h after extubation was not different between the two groups (HHHFNC, 22.2% vs. nCPAP, 18.5%, risk difference of 3.7% and 95% CI −10.3 to 17.6, p = 0.604). The incidence of nasal trauma was significantly lower in the HHHFNC group than in the nCPAP group 6.3% vs. 21.5%, p = 0.020. Conclusions In our study, HHHFNC was as effective as nCPAP for prevention of extubation failure in preterm infants. Also, HHHFNC was associated with significantly less nasal trauma compared with nCPAP.

scholarly journals High-flow nasal cannula for reducing hypoxemic events in patients undergoing bronchoscopy: A systematic review and meta-analysis of randomized trials

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260716
Author(s):  
Chien-Ling Su ◽  
Ling-Ling Chiang ◽  
Ka-Wai Tam ◽  
Tzu-Tao Chen ◽  
Ming-Chi Hu
Keyword(s):  
Systematic Review ◽  
Partial Pressure ◽  
Oxygen Therapy ◽  
Therapy Group ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Cochrane Library ◽  
High Flow Nasal Cannula

Background Patients undergoing bronchoscopic procedures may develop hypoxemia and severe complications. High-flow nasal cannula (HFNC) may prevent hypoxemic events during bronchoscopy. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of HFNC in these patients. Methods We conducted a search in PubMed, Embase, and the Cochrane Library for RCTs published before November 2021. Individual effect sizes were standardized, and a meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the incidence of hypoxemic events (oxygen saturation [SpO2] < 90%) during bronchoscopy. Secondary outcomes included the incidence of interrupted bronchoscopy due to desaturation, lowest SpO2 during bronchoscopy, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), end-tidal CO2 (EtCO2) at the end of bronchoscopy, and the incidence of intubation after the procedure. Results Five trials involving 257 patients were reviewed. The incidence of hypoxemic events was lower in the HFNC group than in the conventional oxygen therapy group (risk ratio, 0.25; 95% confidence interval [CI], 0.14–0.42). The lowest SpO2 during the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (weighted mean difference [WMD], 7.12; 95% CI, 5.39–8.84). PaO2 at the end of the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (WMD, 20.36; 95% CI, 0.30–40.42). The incidence of interrupted bronchoscopy due to desaturation, PaCO2 and EtCO2 at the end of the procedure, and the incidence of intubation after the procedure were not significantly different between groups. Conclusions HFNC may reduce the incidence of hypoxemic events and improve oxygenation in patients undergoing bronchoscopy.

scholarly journals Does propofol ameliorate occurrence of postoperative cognitive dysfunction after general anaesthesia? A protocol of systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Xi Zhao ◽  
Ze-qing Huang
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Short Term Memory ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
China National Knowledge Infrastructure

Abstract Background Postoperative cognitive dysfunction (POCD) is a common condition after general anesthesia (GA). Previous studies have reported that propofol can ameliorate the occurrence of such disorder. However, its results are still inconsistent. Therefore, this systematic review will assess the efficacy and safety of propofol on POCD after GA. Methods Literature sources will be sought from inception to the present in Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for randomized controlled trials (RCTs) assessing the administration of propofol on POCD after GA. All searches will be carried out without limitations to language and publication status. Outcomes comprise of cognitive impairments changes, impairments in short-term memory, concentration, language comprehension, social integration, quality of life, and adverse events. Cochrane risk of bias tool will be utilized to assess study quality. We will evaluate the quality of evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis or a meta-analysis will be undertaken as appropriate. Discussion This study will systematically and comprehensively search literature and integrate evidence on the efficacy and safety of propofol on POCD after GA. Our findings will be of interest to clinicians and health-related policy makers. Systematic review registration PROSPERO CRD42020164096

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