Hospital mortality in patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula oxygen therapy: a cumulative meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2024.01.006

Abstract

Abstract:

Objective

To evaluate the effect of high-flow nasal cannula (HFNC) oxygen therapy on the hospital mortality in patients with acute hypoxemic respiratory failure through a cumulative meta-analysis.

Methods

Randomized controlled trials (RCTs) on the effect of HFNC on patients with acute hypoxemic respiratory failure published up to June 30, 2022 were searched from PubMed, Web of Science, the Cochrane Library, CNKI, VIP and Wanfang databases. Patients in the experimental group received HFNC oxygen therapy, while patients in the control group were treated with face mask (FM) or noninvasive positive pressure ventilation (NIPPV) oxygen therapy. Relevant data were screened, evaluated and extracted by two researchers independently. Then the StataSE 12.0 software was utilized for a cumulative meta-analysis, and the trial sequential analysis (TSA) was used to evaluate the research results.

Results

A total of 2 989 patients were enrolled in 11 articles, including 1 464 in the experimental group and 1 525 in the control group (830 in FM and 695 in NIPPV). The cumulative meta-analysis showed that HFNC could reduce the hospital mortality of patients with acute hypoxemic respiratory failure [relative risk (RR) = 0.66, 95% confidence interval (CI) (0.51, 0.86), Z = 3.050, P = 0.002]. The TSA showed that the sample size of hospital mortality (n = 2 989) had not reached the required information size (RIS, n = 3 997), but the cumulative Z-value had crossed the traditional cut-off value and TSA cut-off value, indicating that the study obtained relatively positive results.

Conclusion

The HFNC oxygen therapy can effectively reduce the hospital mortality of patients with acute hypoxemic respiratory failure.

Key words: High-flow nasal cannula oxygen therapy, Noninvasive positive pressure ventilation, Acute hypoxemic respiratory failure, Cumulative meta-analysis, Trial sequential analysis

Weigang Yue, Youfei Jiang, Ruiyuan Yin, Yuchen Wu, Li Zeng, Jinhui Tian. Hospital mortality in patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula oxygen therapy: a cumulative meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(01): 39-44.

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References 22

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纳入研究	例数（例）		男/女（例）		年龄[岁， ± s或M（P₂₅，P₇₅）]		干预措施		结局指标
纳入研究	试验组	对照组	试验组	对照组	试验组	对照组	试验组	对照组	结局指标
Parke等^[5]	169	171	129/40	129/42	65 ± 17.2	66 ± 16.9	HFNC	FM	住院病死率
Maggiore等^[6]	53	52	33/20	35/18	65 ± 18	64 ± 17	HFNC	FM	住院病死率
Futier等^[7]	108	112	61/47	64/48	62 ± 12	61 ± 13	HFNC	FM	住院病死率
Jones等^[8]	165	138	73/92	71/67	74.6 ± 15.6	72.2 ± 16.8	HFNC	FM	住院病死率
Hernandez等^[9]	264	263	164/100	154/109	51.0 ± 13.1	51.8 ± 12.2	HFNC	FM	住院病死率
Frat等^[10]	106	204	75/31	137/67	61 ± 16	61 ± 17	HFNC	FM/NIPPV	住院病死率
Stephan等^[11]	414	416	273/141	278/138	63.8 ± 12.7	63.9 ± 13.1	HFNC	NIPPV	住院病死率
Coudroy等^[12]	33	24	17/16	18/6	62 ± 11.0	62 ± 11.0	HFNC	NIPPV	住院病死率
Yoo等^[13]	34	39	18/16	25/14	62.1 ± 16.8	62.9 ± 16.1	HFNC	NIPPV	住院病死率
Chang等^[14]	58	46	37/21	28/18	74.5（63.8，82.3）	72.5（61.8，79）	HFNC	NIPPV	住院病死率
Shang等^[15]	60	60	32/28	39/21	67.4 ± 4.8	66.8 ± 6.9	HFNC	NIPPV	住院病死率

纳入研究	例数（例）		男/女（例）		年龄[岁， ± s或M（P₂₅，P₇₅）]		干预措施		结局指标
纳入研究	试验组	对照组	试验组	对照组	试验组	对照组	试验组	对照组	结局指标
Parke等^[5]	169	171	129/40	129/42	65 ± 17.2	66 ± 16.9	HFNC	FM	住院病死率
Maggiore等^[6]	53	52	33/20	35/18	65 ± 18	64 ± 17	HFNC	FM	住院病死率
Futier等^[7]	108	112	61/47	64/48	62 ± 12	61 ± 13	HFNC	FM	住院病死率
Jones等^[8]	165	138	73/92	71/67	74.6 ± 15.6	72.2 ± 16.8	HFNC	FM	住院病死率
Hernandez等^[9]	264	263	164/100	154/109	51.0 ± 13.1	51.8 ± 12.2	HFNC	FM	住院病死率
Frat等^[10]	106	204	75/31	137/67	61 ± 16	61 ± 17	HFNC	FM/NIPPV	住院病死率
Stephan等^[11]	414	416	273/141	278/138	63.8 ± 12.7	63.9 ± 13.1	HFNC	NIPPV	住院病死率
Coudroy等^[12]	33	24	17/16	18/6	62 ± 11.0	62 ± 11.0	HFNC	NIPPV	住院病死率
Yoo等^[13]	34	39	18/16	25/14	62.1 ± 16.8	62.9 ± 16.1	HFNC	NIPPV	住院病死率
Chang等^[14]	58	46	37/21	28/18	74.5（63.8，82.3）	72.5（61.8，79）	HFNC	NIPPV	住院病死率
Shang等^[15]	60	60	32/28	39/21	67.4 ± 4.8	66.8 ± 6.9	HFNC	NIPPV	住院病死率

纳入研究	随机方法	分配隐藏	盲法	结果数据完整性	选择性报告研究结果	其他偏倚来源	质量等级
Parke等^[5]	低风险	低风险	不清楚	低风险	低风险	不清楚	B
Maggiore等^[6]	低风险	低风险	低风险	低风险	低风险	不清楚	B
Futier等^[7]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Jones等^[8]	低风险	低风险	低风险	低风险	低风险	不清楚	B
Hernandez等^[9]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Frat等^[10]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Stephan等^[11]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Coudroy等^[12]	中风险	不清楚	不清楚	低风险	低风险	不清楚	C
Yoo等^[13]	中风险	不清楚	不清楚	低风险	低风险	不清楚	C
Chang等^[14]	中风险	不清楚	不清楚	低风险	低风险	不清楚	C
Shang等^[15]	低风险	不清楚	不清楚	低风险	低风险	不清楚	B

纳入研究	随机方法	分配隐藏	盲法	结果数据完整性	选择性报告研究结果	其他偏倚来源	质量等级
Parke等^[5]	低风险	低风险	不清楚	低风险	低风险	不清楚	B
Maggiore等^[6]	低风险	低风险	低风险	低风险	低风险	不清楚	B
Futier等^[7]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Jones等^[8]	低风险	低风险	低风险	低风险	低风险	不清楚	B
Hernandez等^[9]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Frat等^[10]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Stephan等^[11]	低风险	低风险	低风险	低风险	低风险	不清楚	A
Coudroy等^[12]	中风险	不清楚	不清楚	低风险	低风险	不清楚	C
Yoo等^[13]	中风险	不清楚	不清楚	低风险	低风险	不清楚	C
Chang等^[14]	中风险	不清楚	不清楚	低风险	低风险	不清楚	C
Shang等^[15]	低风险	不清楚	不清楚	低风险	低风险	不清楚	B

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