Effect of high-flow nasal cannula oxygen therapy compared with conventional oxygen therapy in postoperative patients: a systematic review and meta-analysis
Effect of high-flow nasal cannula oxygen therapy compared with conventional oxygen therapy in postoperative patients: a systematic review and meta-analysis
复制标题
术后患者高流量鼻导管氧疗与常规氧疗的效果对比：系统评价和荟萃分析
DOI：
10.1136/bmjopen-2018-027523
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发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Guo, Fengmei
中科院分区：
文献类型：
--
作者：
Lu, Zhonghua;Chang, Wei;Guo, Fengmei
目的评价高流量鼻导管氧疗（HFNC）与常规氧疗（COT）对成人外科拔管后患者再插管率、呼吸支持升级率及临床结局的影响。设计对已发表文献进行系统回顾和荟萃分析。检索了截至2018年8月的PubMed、Embase、科克伦图书馆、Web of Science、中国国家知识索引和万方数据库的数据源。合格性标准在术后成人手术患者（≥18岁）中进行的研究，在拔管后立即应用HFNC或COT，报告了重新插管、呼吸支持升级、术后肺部并发症（PPC）和死亡率，符合入选条件。数据提取和综合从纳入的研究中提取以下数据：第一作者姓名、出版年份、研究人群、来源国、研究设计、患者人数、患者基线特征和结局。使用风险比（RR）和95% CI评估相关性。结果纳入10篇文献（1327例患者）。与COT相比，HFNC显著降低了拔管后手术患者的再插管率（RR 0.38，95% CI 0.23至0.61，p<0.0001）和呼吸支持的增加率（RR 0.43，95% CI 0.26至0.73，p=0.002）。PPC发生率（RR 0.87，95% CI 0.70 - 1.08，p=0.21）或死亡率（RR 0.45，95% CI 0.16 - 1.29，p=0.14）无差异。结论HFNC与COT相比，可显著降低拔管后成人外科患者的再插管率和呼吸支持的增加率，但两者在PPC发生率和死亡率方面无差异。需要更多设计良好的大型随机对照试验来确定最有可能从HFNC治疗中获益的患者亚群。
Objective To evaluate the effect of high-flow nasal cannula oxygen therapy (HFNC) versus conventional oxygen therapy (COT) on the reintubation rate, rate of escalation of respiratory support and clinical outcomes in postextubation adult surgical patients. Design Systematic review and meta-analysis of published literature. Data sources PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Index and Wan fang databases were searched up to August 2018. Eligibility criteria Studies in postoperative adult surgical patients (≥18 years), receiving HFNC or COT applied immediately after extubation that reported reintubation, escalation of respiratory support, postoperative pulmonary complications (PPCs) and mortality were eligible for inclusion. Data extraction and synthesis The following data were extracted from the included studies: first author’s name, year of publication, study population, country of origin, study design, number of patients, patients’ baseline characteristics and outcomes. Associations were evaluated using risk ratio (RR) and 95% CIs. Results This meta-analysis included 10 studies (1327 patients). HFNC significantly reduced the reintubation rate (RR 0.38, 95% CI 0.23 to 0.61, p<0.0001) and rate of escalation of respiratory support (RR 0.43, 95% CI 0.26 to 0.73, p=0.002) in postextubation surgical patients compared with COT. There were no differences in the incidence of PPCs (RR 0.87, 95% CI 0.70 to 1.08, p=0.21) or mortality (RR 0.45, 95% CI 0.16 to 1.29, p=0.14). Conclusion HFNC is associated with a significantly lower reintubation rate and rate of escalation of respiratory support compared with COT in postextubation adult surgical patients, but there is no difference in the incidence of PPCs or mortality. More well-designed, large randomised controlled trials are needed to determine the subpopulation of patients who are most likely to benefit from HFNC therapy.