Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Chaudhuri, Dipayan; Granton, David; Wang, Dominic Xiang; Einav, Sharon; Helviz, Yigal; Mauri, Tommaso; Ricard, Jean-Damien; Mancebo, Jordi; Frat, Jean-Pierre; Jog, Sameer; Hernandez, Gonzalo; Maggiore, Salvatore M.; Hodgson, Carol; Jaber, Samir; Brochard, Laurent; Burns, Karen E. A.; Rochwerg, Bram
• Is Part Of: Critical care medicine. Volume 48:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: artificial respiration -- hypoxia -- intubation -- noninvasive ventilation -- oxygen inhalation therapy -- systematic review; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000004217
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objective: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period. Data Sources: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science). Study Selection: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period. Data Extraction: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, PaO2 before and after intubation, PaCO2 after intubation, ICU length of stay, and short-term mortality. Data Synthesis: We included 10 randomized clinical trials ( n = 1, 017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68–1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71–1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), PaO2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or PaO2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation PaCO2, ICU length of stay, or 28-day mortality. Conclusions: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy. Abstract : Supplemental Digital Content is available in the text.