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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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, 商鸣宇, 黄克武, 等. 有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究. 中华结核和呼吸杂志, 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, Huët 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, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
7.	李玉川. 经鼻高流量湿化氧疗在COPD合并2型呼吸衰竭患者气管插管拔管后的应用价值分析. 系统医学, 2020, 5(18): 35-37.
8.	高致炳, 范迪堃, 杨侃. HFNCO治疗心血管外科心脏术后低氧血症的疗效观察. 中西医结合心脑血管病杂志, 2020, 18(18): 3079-3082.
9.	黄静铭, 梁志金, 黄连意. 经鼻高流量氧疗与无创正压通气在AECOPD病人拔管后序贯治疗的效果观察. 循证护理, 2020, 6(6): 565-569.
10.	袁诚忱. 经鼻高流量氧疗和无创通气交替应用在肺移植术后已拔除人工气道患者中的临床效果. 医疗装备, 2020, 33(11): 177-179.
11.	顾彩虹, 刘素霞, 刘克喜, 等. 高流量氧疗与无创正压通气对全麻胃肠手术后急性呼吸衰竭患者氧疗效果及预后影响的前瞻性随机对照研究. 中华急诊医学杂志, 2020, 29(2): 262-267.
12.	黄金桔, 蔡晶晶, 蔡颖, 等. 经鼻高流量氧疗在急性呼吸衰竭患者拔管后的应用效果. 中国当代医药, 2019, 26(35): 42-44, 48.
13.	於江泉, 郑瑞强, 朱进, 等. 经鼻高流量氧疗在慢性阻塞性肺疾病急性加重患者有创呼吸机序贯治疗中的临床效果. 中华重症医学电子杂志(网络版), 2019, 5(3): 213-218.
14.	韩晓霖, 刘述平, 刘一诚, 等. 经鼻高流量氧疗对AECOPD患者撤机效果的影响. 湖南师范大学学报(医学版), 2018, 15(1): 145-148.
15.	陈静. 高流量吸氧湿化治疗仪在重症肺炎合并急性呼吸窘迫症患者中的应用. 中国医疗器械信息, 2020, 26(18): 113-114, 137.
16.	徐晓翠, 王金柱, 姚惠萍. 经鼻高流量湿化氧疗对COPD患者拔管后再插管及呼吸衰竭的影响. 齐鲁护理杂志, 2018, 24(5): 1-3.
17.	岳爱君. 经鼻高流量氧疗序贯治疗慢性阻塞性肺疾病机械通气患者的效果及安全性. 医疗装备, 2020, 33(12): 3-4.
18.	张春华. 三种氧疗方式对AECOPD患者拔管后的疗效研究. 青岛: 青岛大学, 2018.
19.	王大鹏, 聂晓伟, 潘红, 等. 经鼻高流量湿化氧疗治疗肺移植术后移植物失功患者的临床研究. 现代生物医学进展, 2018, 17(34): 6709-6712.
20.	李志伟, 李超, 董权, 等. 经鼻高流量氧疗与无创通气治疗腹部外科术后患者脱机后低氧血症的临床疗效比较. 昆明医科大学学报, 2017, 38(1): 65-69.
21.	张辉, 李盼, 包永飞, 等. 拔管后经鼻高流量氧疗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应用效果. 中国实用医刊, 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, 吴雨晨, 岳伟岗, 等. 急性加重期COPD患者拔管后经鼻高流量氧疗效果的Meta分析. 中国护理管理, 2020, 20(3): 406-412.
27.	简佳庆, 段凤英, 肖远超, 等. ICU拔除气管插管患者使用经鼻高流量湿化氧疗对比传统氧疗或无创正压通气临床疗效的Meta分析. 中国呼吸与危重监护杂志, 2019, 18(1): 42-50.
28.	李丽莉, 代冰, 董新新. 患者拔除气管插管后应用经鼻高流量氧疗效果的Meta分析. 中华护理杂志, 2018, 53(12): 1492-1497.
29.	董新新. 经鼻高流量氧疗在拔除气管插管后患者中序贯应用疗效的meta分析. 沈阳: 中国医科大学, 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.	刘玲, 范杰梅, 张爱琴. 高流量氧疗对免疫缺陷合并急性呼吸衰竭患者疗效的Meta分析. 中国呼吸与危重监护杂志, 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, 商鸣宇, 黄克武, 等. 有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究. 中华结核和呼吸杂志, 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, Huët 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, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
7. 李玉川. 经鼻高流量湿化氧疗在COPD合并2型呼吸衰竭患者气管插管拔管后的应用价值分析. 系统医学, 2020, 5(18): 35-37.
8. 高致炳, 范迪堃, 杨侃. HFNCO治疗心血管外科心脏术后低氧血症的疗效观察. 中西医结合心脑血管病杂志, 2020, 18(18): 3079-3082.
9. 黄静铭, 梁志金, 黄连意. 经鼻高流量氧疗与无创正压通气在AECOPD病人拔管后序贯治疗的效果观察. 循证护理, 2020, 6(6): 565-569.
10. 袁诚忱. 经鼻高流量氧疗和无创通气交替应用在肺移植术后已拔除人工气道患者中的临床效果. 医疗装备, 2020, 33(11): 177-179.
11. 顾彩虹, 刘素霞, 刘克喜, 等. 高流量氧疗与无创正压通气对全麻胃肠手术后急性呼吸衰竭患者氧疗效果及预后影响的前瞻性随机对照研究. 中华急诊医学杂志, 2020, 29(2): 262-267.
12. 黄金桔, 蔡晶晶, 蔡颖, 等. 经鼻高流量氧疗在急性呼吸衰竭患者拔管后的应用效果. 中国当代医药, 2019, 26(35): 42-44, 48.
13. 於江泉, 郑瑞强, 朱进, 等. 经鼻高流量氧疗在慢性阻塞性肺疾病急性加重患者有创呼吸机序贯治疗中的临床效果. 中华重症医学电子杂志(网络版), 2019, 5(3): 213-218.
14. 韩晓霖, 刘述平, 刘一诚, 等. 经鼻高流量氧疗对AECOPD患者撤机效果的影响. 湖南师范大学学报(医学版), 2018, 15(1): 145-148.
15. 陈静. 高流量吸氧湿化治疗仪在重症肺炎合并急性呼吸窘迫症患者中的应用. 中国医疗器械信息, 2020, 26(18): 113-114, 137.
16. 徐晓翠, 王金柱, 姚惠萍. 经鼻高流量湿化氧疗对COPD患者拔管后再插管及呼吸衰竭的影响. 齐鲁护理杂志, 2018, 24(5): 1-3.
17. 岳爱君. 经鼻高流量氧疗序贯治疗慢性阻塞性肺疾病机械通气患者的效果及安全性. 医疗装备, 2020, 33(12): 3-4.
18. 张春华. 三种氧疗方式对AECOPD患者拔管后的疗效研究. 青岛: 青岛大学, 2018.
19. 王大鹏, 聂晓伟, 潘红, 等. 经鼻高流量湿化氧疗治疗肺移植术后移植物失功患者的临床研究. 现代生物医学进展, 2018, 17(34): 6709-6712.
20. 李志伟, 李超, 董权, 等. 经鼻高流量氧疗与无创通气治疗腹部外科术后患者脱机后低氧血症的临床疗效比较. 昆明医科大学学报, 2017, 38(1): 65-69.
21. 张辉, 李盼, 包永飞, 等. 拔管后经鼻高流量氧疗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应用效果. 中国实用医刊, 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, 吴雨晨, 岳伟岗, 等. 急性加重期COPD患者拔管后经鼻高流量氧疗效果的Meta分析. 中国护理管理, 2020, 20(3): 406-412.
27. 简佳庆, 段凤英, 肖远超, 等. ICU拔除气管插管患者使用经鼻高流量湿化氧疗对比传统氧疗或无创正压通气临床疗效的Meta分析. 中国呼吸与危重监护杂志, 2019, 18(1): 42-50.
28. 李丽莉, 代冰, 董新新. 患者拔除气管插管后应用经鼻高流量氧疗效果的Meta分析. 中华护理杂志, 2018, 53(12): 1492-1497.
29. 董新新. 经鼻高流量氧疗在拔除气管插管后患者中序贯应用疗效的meta分析. 沈阳: 中国医科大学, 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. 刘玲, 范杰梅, 张爱琴. 高流量氧疗对免疫缺陷合并急性呼吸衰竭患者疗效的Meta分析. 中国呼吸与危重监护杂志, 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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