Meta-analysis of sequential efficacy of intranasal high-flow oxygen therapy versus non-invasive mechanical ventilation in invasive mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Hao ^1,2 , DONG Zhaotong ³ , YANG Yang ⁴ ,  QU Nini ⁵

1. Graduate School of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning 110847, P. R. China;
2. Intensive Care Unit, Dalian Hospital of Traditional Chinese Medicine, Dalian, Liaoning 116000, P. R. China;
3. Graduate School of Dalian Medical University, Dalian, Liaoning 116044, P. R. China;
4. Department of Traditional Chinese Medicine, The First Affiliated Hospital of Dalian Medicine University, Dalian, Liaoning 116000, P. R. China;
5. Department of Respiratory, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning 110032, P. R. China;

Corresponding?author：

QU Nini, Email: 21653160@qq.com

Keywords：

Transnasal high flow oxygen therapy; non-invasive mechanical ventilation; invasive mechanical ventilation

DOI：

10.7507/1671-6205.202106042

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the sequential efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive mechanical ventilation (NIV). Methods Randomized controlled trials comparing the efficacy of NIV sequential invasive mechanical ventilation with HFNC were included in the Chinese Journal Full-text Database, VIP Journal database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Cochrane Library and Embase. Meta-analysis was performed using RevMan5.4 software. Results A total of 2404 subjects were included in 19 studies. Meta-analysis results showed that compared with NIV, HFNC had a statistically significant difference in reducing patients' re-intubation rate in invasive mechanical ventilation sequence [relative risk (RR)=0.65, 95% confidence interval (CI) 0.50 - 0.86, Z=3.10, P=0.002]. HFNC showed statistically significant difference compared with NIV in reducing lung infection rate (RR=0.40, 95%CI 0.21 - 0.79, Z=2.67, P=0.008). HFNC was significantly different from NIV in terms of length of stay in Intensive Care Unit (ICU) (MD=–5.77, 95%CI –7.64 - –3.90, Z=6.05, P<0.00001). HFNC was significantly different from NIV in improving 24 h oxygenation index (MD=13.16, 95%CI 8.77 - 17.55, Z=5.87, P<0.00001). There was no significant difference in ICU mortality between HFNC and NIV (RR=0.70, 95%CI 0.45 - 1.08, Z=1.61, P=0.11). Conclusion Compared with NIV, sequential application of HFNC in invasive mechanical ventilation can improve the reintubation rate and pulmonary infection rate to a certain extent, reduce the length of ICU stay and improve the 24 h oxygenation index, while there is no difference in ICU mortality, which is worthy of clinical application.

Citation： LIU Hao, DONG Zhaotong, YANG Yang, QU Nini. Meta-analysis of sequential efficacy of intranasal high-flow oxygen therapy versus non-invasive mechanical ventilation in invasive mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(11): 773-781. doi: 10.7507/1671-6205.202106042 Copy

1.	Drake MG. High-flow nasal cannula oxygen in adults: an evidence-based assessment. Ann Am Thorac Soc, 2018, 15(2): 145-155.
2.	Boccatonda A, Groff P. High-flow nasal cannula oxygenation utilization in respiratory failure. Eur J Intern Med, 2019, 64: 10-14.
3.	王辰, 商鳴宇, 黃克武, 等. 有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的研究. 中華結核和呼吸雜志, 2000, 23(4): 212-216.
4.	Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med, 2016, 42(9): 1336-1349.
5.	Clark HD, Wells GA, Hu?t C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials, 1999, 20(5): 448-452.
6.	Higgins JP, Altman DG, G?tzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
7.	李玉川. 經鼻高流量濕化氧療在COPD合并2型呼吸衰竭患者氣管插管拔管后的應用價值分析. 系統醫學, 2020, 5(18): 35-37.
8.	高致炳, 范迪堃, 楊侃. HFNCO治療心血管外科心臟術后低氧血癥的療效觀察. 中西醫結合心腦血管病雜志, 2020, 18(18): 3079-3082.
9.	黃靜銘, 梁志金, 黃連意. 經鼻高流量氧療與無創正壓通氣在AECOPD病人拔管后序貫治療的效果觀察. 循證護理, 2020, 6(6): 565-569.
10.	袁誠忱. 經鼻高流量氧療和無創通氣交替應用在肺移植術后已拔除人工氣道患者中的臨床效果. 醫療裝備, 2020, 33(11): 177-179.
11.	顧彩虹, 劉素霞, 劉克喜, 等. 高流量氧療與無創正壓通氣對全麻胃腸手術后急性呼吸衰竭患者氧療效果及預后影響的前瞻性隨機對照研究. 中華急診醫學雜志, 2020, 29(2): 262-267.
12.	黃金桔, 蔡晶晶, 蔡穎, 等. 經鼻高流量氧療在急性呼吸衰竭患者拔管后的應用效果. 中國當代醫藥, 2019, 26(35): 42-44, 48.
13.	於江泉, 鄭瑞強, 朱進, 等. 經鼻高流量氧療在慢性阻塞性肺疾病急性加重患者有創呼吸機序貫治療中的臨床效果. 中華重癥醫學電子雜志(網絡版), 2019, 5(3): 213-218.
14.	韓曉霖, 劉述平, 劉一誠, 等. 經鼻高流量氧療對AECOPD患者撤機效果的影響. 湖南師范大學學報(醫學版), 2018, 15(1): 145-148.
15.	陳靜. 高流量吸氧濕化治療儀在重癥肺炎合并急性呼吸窘迫癥患者中的應用. 中國醫療器械信息, 2020, 26(18): 113-114, 137.
16.	徐曉翠, 王金柱, 姚惠萍. 經鼻高流量濕化氧療對COPD患者拔管后再插管及呼吸衰竭的影響. 齊魯護理雜志, 2018, 24(5): 1-3.
17.	岳愛君. 經鼻高流量氧療序貫治療慢性阻塞性肺疾病機械通氣患者的效果及安全性. 醫療裝備, 2020, 33(12): 3-4.
18.	張春華. 三種氧療方式對AECOPD患者拔管后的療效研究. 青島: 青島大學, 2018.
19.	王大鵬, 聶曉偉, 潘紅, 等. 經鼻高流量濕化氧療治療肺移植術后移植物失功患者的臨床研究. 現代生物醫學進展, 2018, 17(34): 6709-6712.
20.	李志偉, 李超, 董權, 等. 經鼻高流量氧療與無創通氣治療腹部外科術后患者脫機后低氧血癥的臨床療效比較. 昆明醫科大學學報, 2017, 38(1): 65-69.
21.	張輝, 李盼, 包永飛, 等. 拔管后經鼻高流量氧療在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者中的應用效果. 中國實用醫刊, 2020, 47(8): 88-91.
22.	Chen J, Lin YY, Du LL, et al. The Comparison of HHHFNC and NCPAP in extremely low-birth-weight preterm infants after extubation: a single-center randomized controlled trial. Front Pediatr, 2020, 8: 250.
23.	Jing GQ, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health, 2019, 42(3): 217-225.
24.	Uchiyama A, Okazaki K, Kondo M, et al; NON-INVASIVE PROCEDURE FOR PREMATURE NEONATES (NIPPN) STUDY GROUP. Randomized controlled trial of high-flow nasal cannula in preterm infants after extubation. Pediatrics, 2020, 146(6): e20201101.
25.	Liu F, Shao Q, Jiang R, et al. High-flow oxygen therapy to speed weaning from mechanical ventilation: a prospective randomized study. Am J Crit Care, 2019, 28(5): 370-376.
26.	高慧雅, 吳雨晨, 岳偉崗, 等. 急性加重期COPD患者拔管后經鼻高流量氧療效果的Meta分析. 中國護理管理, 2020, 20(3): 406-412.
27.	簡佳慶, 段鳳英, 肖遠超, 等. ICU拔除氣管插管患者使用經鼻高流量濕化氧療對比傳統氧療或無創正壓通氣臨床療效的Meta分析. 中國呼吸與危重監護雜志, 2019, 18(1): 42-50.
28.	李麗莉, 代冰, 董新新. 患者拔除氣管插管后應用經鼻高流量氧療效果的Meta分析. 中華護理雜志, 2018, 53(12): 1492-1497.
29.	董新新. 經鼻高流量氧療在拔除氣管插管后患者中序貫應用療效的meta分析. 沈陽: 中國醫科大學, 2018.
30.	Lamba TS, Sharara RS, Singh AC, et al. Pathophysiology and classification of respiratory failure. Crit Care Nurs Q, 2016, 39(2): 85-93.
31.	Singer BD, Corbridge TC. Basic invasive mechanical ventilation. South Med J, 2009, 102(12): 1238-1245.
32.	Guilhermino MC, Inder KJ, Sundin D. Education on invasive mechanical ventilation involving intensive care nurses: a systematic review. Nurs Crit Care, 2018, 23(5): 245-255.
33.	Rose L. Strategies for weaning from mechanical ventilation: a state of the art review. Intensive Crit Care Nurs, 2015, 31(4): 189-195.
34.	Yeung J, Couper K, Ryan EG, et al. Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation: a systematic review and Bayesian meta-analysis. Intensive Care Med, 2018, 44(12): 2192-2204.
35.	Kim BK, Kim S, Kim CY, et al. Factors associated with failure of high-flow nasal cannula. Respir Care, 2020, 65(9): 1276-1284.
36.	Lewis SR, Baker PE, Parker R, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev, 2021, 3(3): CD010172.
37.	Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care, 2016, 61(4): 529-541.
38.	劉玲, 范杰梅, 張愛琴. 高流量氧療對免疫缺陷合并急性呼吸衰竭患者療效的Meta分析. 中國呼吸與危重監護雜志, 2021, 20(1): 22-31.

1. Drake MG. High-flow nasal cannula oxygen in adults: an evidence-based assessment. Ann Am Thorac Soc, 2018, 15(2): 145-155.
2. Boccatonda A, Groff P. High-flow nasal cannula oxygenation utilization in respiratory failure. Eur J Intern Med, 2019, 64: 10-14.
3. 王辰, 商鳴宇, 黃克武, 等. 有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的研究. 中華結核和呼吸雜志, 2000, 23(4): 212-216.
4. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med, 2016, 42(9): 1336-1349.
5. Clark HD, Wells GA, Hu?t C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials, 1999, 20(5): 448-452.
6. Higgins JP, Altman DG, G?tzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
7. 李玉川. 經鼻高流量濕化氧療在COPD合并2型呼吸衰竭患者氣管插管拔管后的應用價值分析. 系統醫學, 2020, 5(18): 35-37.
8. 高致炳, 范迪堃, 楊侃. HFNCO治療心血管外科心臟術后低氧血癥的療效觀察. 中西醫結合心腦血管病雜志, 2020, 18(18): 3079-3082.
9. 黃靜銘, 梁志金, 黃連意. 經鼻高流量氧療與無創正壓通氣在AECOPD病人拔管后序貫治療的效果觀察. 循證護理, 2020, 6(6): 565-569.
10. 袁誠忱. 經鼻高流量氧療和無創通氣交替應用在肺移植術后已拔除人工氣道患者中的臨床效果. 醫療裝備, 2020, 33(11): 177-179.
11. 顧彩虹, 劉素霞, 劉克喜, 等. 高流量氧療與無創正壓通氣對全麻胃腸手術后急性呼吸衰竭患者氧療效果及預后影響的前瞻性隨機對照研究. 中華急診醫學雜志, 2020, 29(2): 262-267.
12. 黃金桔, 蔡晶晶, 蔡穎, 等. 經鼻高流量氧療在急性呼吸衰竭患者拔管后的應用效果. 中國當代醫藥, 2019, 26(35): 42-44, 48.
13. 於江泉, 鄭瑞強, 朱進, 等. 經鼻高流量氧療在慢性阻塞性肺疾病急性加重患者有創呼吸機序貫治療中的臨床效果. 中華重癥醫學電子雜志(網絡版), 2019, 5(3): 213-218.
14. 韓曉霖, 劉述平, 劉一誠, 等. 經鼻高流量氧療對AECOPD患者撤機效果的影響. 湖南師范大學學報(醫學版), 2018, 15(1): 145-148.
15. 陳靜. 高流量吸氧濕化治療儀在重癥肺炎合并急性呼吸窘迫癥患者中的應用. 中國醫療器械信息, 2020, 26(18): 113-114, 137.
16. 徐曉翠, 王金柱, 姚惠萍. 經鼻高流量濕化氧療對COPD患者拔管后再插管及呼吸衰竭的影響. 齊魯護理雜志, 2018, 24(5): 1-3.
17. 岳愛君. 經鼻高流量氧療序貫治療慢性阻塞性肺疾病機械通氣患者的效果及安全性. 醫療裝備, 2020, 33(12): 3-4.
18. 張春華. 三種氧療方式對AECOPD患者拔管后的療效研究. 青島: 青島大學, 2018.
19. 王大鵬, 聶曉偉, 潘紅, 等. 經鼻高流量濕化氧療治療肺移植術后移植物失功患者的臨床研究. 現代生物醫學進展, 2018, 17(34): 6709-6712.
20. 李志偉, 李超, 董權, 等. 經鼻高流量氧療與無創通氣治療腹部外科術后患者脫機后低氧血癥的臨床療效比較. 昆明醫科大學學報, 2017, 38(1): 65-69.
21. 張輝, 李盼, 包永飛, 等. 拔管后經鼻高流量氧療在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者中的應用效果. 中國實用醫刊, 2020, 47(8): 88-91.
22. Chen J, Lin YY, Du LL, et al. The Comparison of HHHFNC and NCPAP in extremely low-birth-weight preterm infants after extubation: a single-center randomized controlled trial. Front Pediatr, 2020, 8: 250.
23. Jing GQ, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health, 2019, 42(3): 217-225.
24. Uchiyama A, Okazaki K, Kondo M, et al; NON-INVASIVE PROCEDURE FOR PREMATURE NEONATES (NIPPN) STUDY GROUP. Randomized controlled trial of high-flow nasal cannula in preterm infants after extubation. Pediatrics, 2020, 146(6): e20201101.
25. Liu F, Shao Q, Jiang R, et al. High-flow oxygen therapy to speed weaning from mechanical ventilation: a prospective randomized study. Am J Crit Care, 2019, 28(5): 370-376.
26. 高慧雅, 吳雨晨, 岳偉崗, 等. 急性加重期COPD患者拔管后經鼻高流量氧療效果的Meta分析. 中國護理管理, 2020, 20(3): 406-412.
27. 簡佳慶, 段鳳英, 肖遠超, 等. ICU拔除氣管插管患者使用經鼻高流量濕化氧療對比傳統氧療或無創正壓通氣臨床療效的Meta分析. 中國呼吸與危重監護雜志, 2019, 18(1): 42-50.
28. 李麗莉, 代冰, 董新新. 患者拔除氣管插管后應用經鼻高流量氧療效果的Meta分析. 中華護理雜志, 2018, 53(12): 1492-1497.
29. 董新新. 經鼻高流量氧療在拔除氣管插管后患者中序貫應用療效的meta分析. 沈陽: 中國醫科大學, 2018.
30. Lamba TS, Sharara RS, Singh AC, et al. Pathophysiology and classification of respiratory failure. Crit Care Nurs Q, 2016, 39(2): 85-93.
31. Singer BD, Corbridge TC. Basic invasive mechanical ventilation. South Med J, 2009, 102(12): 1238-1245.
32. Guilhermino MC, Inder KJ, Sundin D. Education on invasive mechanical ventilation involving intensive care nurses: a systematic review. Nurs Crit Care, 2018, 23(5): 245-255.
33. Rose L. Strategies for weaning from mechanical ventilation: a state of the art review. Intensive Crit Care Nurs, 2015, 31(4): 189-195.
34. Yeung J, Couper K, Ryan EG, et al. Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation: a systematic review and Bayesian meta-analysis. Intensive Care Med, 2018, 44(12): 2192-2204.
35. Kim BK, Kim S, Kim CY, et al. Factors associated with failure of high-flow nasal cannula. Respir Care, 2020, 65(9): 1276-1284.
36. Lewis SR, Baker PE, Parker R, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev, 2021, 3(3): CD010172.
37. Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care, 2016, 61(4): 529-541.
38. 劉玲, 范杰梅, 張愛琴. 高流量氧療對免疫缺陷合并急性呼吸衰竭患者療效的Meta分析. 中國呼吸與危重監護雜志, 2021, 20(1): 22-31.

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Meta-analysis of sequential efficacy of intranasal high-flow oxygen therapy versus non-invasive mechanical ventilation in invasive mechanical ventilation

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