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RESEARCH PRODUCT
High flow nasal therapy in immunocompromised patients with acute respiratory failure: A systematic review and meta-analysis.
Claudia CrimiCesare GregorettiFilippo SanfilippoGiacomo GrasselliAntonino GiarratanoDavide Di FalcoAndrea CortegianiAlberto Notosubject
medicine.medical_specialtyCritical CareAcute respiratory failure High flow nasal cannula High flow nasal therapy Immunocompromised patients Mechanical ventilation Noninvasive ventilation Oxygen therapy Cannula Humans Immunocompromised Host Intubation Intratracheal Noninvasive Ventilation Oxygen Inhalation Therapy Randomized Controlled Trials as Topic Respiratory Distress Syndrome Adult Critical Caremedicine.medical_treatmentAcute respiratory failureCritical Care and Intensive Care Medicinelaw.inventionImmunocompromised Host03 medical and health sciencesMechanical ventilation0302 clinical medicineRandomized controlled triallawInternal medicineOxygen therapyIntubation IntratrachealImmunocompromised patientmedicineCannulaHumansIntubationHigh flow nasal therapyRandomized Controlled Trials as TopicRespiratory Distress Syndromebusiness.industryMortality rateOxygen Inhalation Therapy030208 emergency & critical care medicineRetrospective cohort studyOdds ratioOxygen therapyIntensive care unitHigh flow nasal cannula030228 respiratory systemMeta-analysisbusinessNoninvasive ventilationdescription
Abstract Purpose The role of high-flow nasal therapy (HFNT) as compared to conventional oxygen therapy (COT) in immunocompromised patients admitted to intensive care unit (ICU) with acute respiratory failure (ARF) remains unclear. We conducted a systematic review and meta-analysis in order to address this issue. Methods We searched PubMed, Medline and Embase until November 7th, 2018. Randomized controlled trials (RCTs), non-randomized prospective and retrospective evidence were selected. Observational studies were considered for sensitivity analysis. Primary outcome was mortality rate; intubation rate was a secondary outcome. Results We included four studies in the primary analysis: one RCT, two RCT's post-hoc analyses and one retrospective study. We found no significant difference in short-term mortality comparing HFNT vs. COT: 1) ICU: n = 872 patients, odds ratio (OR) = 0.80 [0.44,1.45], p = 0.46, I2 = 30%, p = 0.24; 2) 28-day: n = 996 patients, OR = 0.79 [0.45,1.38], p = 0.40, I2 = 52%, p = 0.12). Conversely, we found a reduction of intubation rate in the HFNT group (n = 1052 patients, OR = 0.74 [0.55,0.98], p = 0.03, I2 = 7%, p = 0.36). The inclusion of one observational study for sensitivity analysis did not grossly change results. Conclusions We found no benefit of HFNT over COT on mortality in immunocompromised patients with ARF. However, HFNT was associated with a lower intubation rate warranting further research.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-01-01 |