Critical Care: 2019 23:180:
Published: 17 May 2019
Background
The
effect of high-flow nasal cannula (HFNC) therapy in patients after planned
extubation remains inconclusive. We aimed to perform a rigorous and
comprehensive systematic meta-analysis to robustly quantify the benefits of
HFNC for patients after planned extubation by investigating postextubation
respiratory failure and other outcomes.
Method
We
searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from
inception to August 2018. Two researchers screened studies and collected the
data independently. Randomized controlled trials (RCTs) and crossover studies
were included. The main outcome was postextubation respiratory failure.
Results
Ten
studies (seven RCTs and three crossover studies; HFNC group: 856 patients;
Conventional oxygen therapy (COT) group: 852 patients) were included. Compared
with COT, HFNC may significantly reduce postextubation respiratory failure (RR,
0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02)
and respiratory rates (standardized mean differences (SMD), − 0.70; 95% CI,
− 1.16, − 0.25; z = 3.03; P = 0.002)
and increase PaO2 (SMD,
0.30; 95% CI, 0.04, 0.56; z = 2.23; P = 0.03).
There were no significant differences in reintubation rate, length of ICU and
hospital stay, comfort score, PaCO2,
mortality in ICU and hospital, and severe adverse events between HFNC and COT
group.
Conclusions
Our
meta-analysis demonstrated that compared with COT, HFNC may significantly
reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered
in patients after planned extubation. Further large-scale, multicenter studies
are needed to confirm our results.
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