Noninvasive oxygenation strategies in adult patients with acute respiratory failure: a protocol for a systematic review and network meta-analysis

Abstract

Background: Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and is associated with high mortality. Noninvasive oxygenation strategies such as high-flow nasal cannula, standard oxygen therapy, and noninvasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network metaanalysis is to summarize the evidence and compare the effect of noninvasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure. Methods: We will search key databases for randomized controlled trials assessing the effect of noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology.(Continued on next page)

Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure

“…This review has been conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols statement extension for network meta-analysis . The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42019121755) and has been published . No institutional review board approval was required because all study data had been published previously and this study did not include individual patient data.…”

Clinical features and prognostic factors of critically ill patients with COVID-19 in Daegu, South Korea

“…In South Korea, the first confirmed case of COVID-19 was reported on January 20, 2020. [ 1 ] In the city of Daegu, the fourth largest city of South Korea with 2.5 million residents, the first COVID-19 case was confirmed on February 18, 2020. Within days, the number of cases surged due to the community transmission within a secretive religious organization.…”

ERS International Congress 2021: highlights from the Respiratory Infections Assembly

“…Results of the NIHR funded RECOVERY-RS trial were presented by Gavin D. Perkins (Birmingham, UK), who highlighted the need for international consensus on the use of noninvasive oxygen therapy in COVID-19 [ 43 , 44 ]. The RECOVERY-RS trial showed that while HFNO did not perform better than conventional oxygen therapy, CPAP decreased the need for mechanical ventilation at 30 days and reduced intensive care admission compared with conventional oxygen therapy [ 40 ].…”