高流量鼻插管(HFNC)和无创通气(NIV)是2019年冠状病毒病(COVID-19)患者急性低氧性呼吸衰竭(AHRF)的重要治疗方法。然而,HFNC和NIV对COVID-19临床结局的不同影响尚不确定。
我们评估了HFNC与NIV(界面或模式)对COVID-19临床结局的影响。
我们搜索了PubMed,EMBASE,WebofScience,Scopus,MedRxiv,和BioRxiv在2022年2月之前以英文发表的关于HFNC和NIV在COVID-19相关AHRF患者中的随机对照试验(RCT)和观察性研究(与对照组)。感兴趣的主要结果是死亡率,次要结果是插管率,PaO2/FiO2,重症监护病房(ICU)住院时间(LOS),医院LOS,和无侵入性机械通气天数[无呼吸机日(VFD)]。
总之,23项研究符合选择标准,纳入5354例患者。NIV组的死亡率高于HFNC组[比值比(OR)=0.66,95%置信区间(CI):0.51-0.84,p=0.0008,I2=60%];在这个子组,NIV头盔组(OR=1.21,95%CI:0.63~2.32,p=0.57,I2=0%)或NIV-持续气道正压通气(CPAP)组(OR=0.77,95%CI:0.51~1.17,p=0.23,I2=65%)与NCHF组相比,死亡率无显著差异.插管率没有差异,PaO2/FiO2,ICULOS,医院LOS,HFNC和NIV组之间无侵入性机械通气(VFD)的天数。
尽管HFNC的死亡率低于NIV,在头盔或CPAP亚组中,HFNC和NIV的死亡率无差异.未来的大样本RCT是必要的,以证明我们的发现。
这项系统评价和荟萃分析方案在PROSPERO进行了前瞻性注册(编号:CRD42022321997).
High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain.
We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19.
We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO2/FiO2, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)].
In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51-0.84, p = 0.0008, I2 = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63-2.32, p = 0.57, I2 = 0%) or NIV-continuous positive airway pressure (
CPAP) group (OR = 0.77, 95% CI: 0.51-1.17, p = 0.23, I2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO2/FiO2, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups.
Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or
CPAP group. Future large sample RCTs are necessary to prove our findings.
This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).