JIAN Jiaqing , DUAN Fengying , XIAO Yuanchao , ZHANG Siying , GAO Fei
  • Department of Respiratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P. R. China;
DUAN Fengying, Email: 346001908@qq.com
Postextubation; High-flow nasal cannula oxygen therapy; Reintubation rate; Length of ICU stay; Intensive care unit mortality; Hospital acquired pneumonia
10.7507/1671-6205.201805050
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Objective To systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in post-extubation intensive care unit (ICU) patients.Methods The PubMed, Embase, Cochrane Library, CNKI, WanFang, VIP Databases were searched for all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy in post-extubation ICU patients. The control group was treated with conventional oxygen therapy (COT) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. Two reviewers separately searched the articles, evaluated the quality of the literatures, extracted data according to the inclusion and exclusion criteria. RevMan5.3 was used for meta-analysis. The main outcome measurements included reintubation rate and length of ICU stay. The secondary outcomes included ICU mortality and hospital acquired pneumonia (HAP) rate.Results A total of 20 articles were enrolled. There were 3 583 patients enrolled, with 1 727 patients in HFNC group, and 1 856 patients in control group (841 patients with COT, and 1 015 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over COT in reducing the reintubation rate of patients with postextubation (P<0.000 01), but there was no significant difference as compared with that of NIPPV (P=0.21). It was shown by pooled analysis of two subgroups that compared with COT/NIPPV, HFNC had a significant advantage in reducing reintubation rate in patients of postextubation (P<0.000 01). There was no significant difference in ICU mortality between HFNC and COT (P=0.38) or NIPPV (P=0.36). There was no significant difference in length of ICU stay between HFNC and COT (P=0.30), but there had a significant advantage in length of ICU stay between HFNC and NIPPV (P<0.000 01). It was shown by pooled analysis of two subgroups that compared with COT/NIPPV, HFNC had a significant advantage in length of ICU stay (P=0.04). There was no significant difference in HAP rate between HFNC and COT (P=0.61) or NIPPV (P=0.23).Conclusions There is a significant advantage to decrease reintubation rate between HFNC and COT, but there is no significant difference in ICU mortality, length of ICU stay or HAP rate. There is a significant advantage to decrease length of ICU stay between HFNC and NIPPV, but there is no significant difference in ICU mortality, reintubation rate or HAP rate.

Citation： JIAN Jiaqing, DUAN Fengying, XIAO Yuanchao, ZHANG Siying, GAO Fei. Clinical efficacy of high-flow nasal cannula oxygen therapy versus conventional oxygen therapy and noninvasive ventilation in ICU patients: a meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(1): 42-50. doi: 10.7507/1671-6205.201805050 Copy

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