Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

Abstract

Background High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively). Conclusion NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation. Trial registration number and date of registration PROSPERO (registration number: CRD42020139112, 01/21/2020).

High-flow nasal cannula oxygen therapy in the weaning of severe burn patients: a preliminary report of data collection

“…HFNC is a NPPV, that gives less probability of tracheal reintubation than conventional oxygen therapy (COT). However, there are not many large-scale studies that have compared HFNC and NPPV [12]. We agree that the use of HFNC operates a relative alveolar de-recruitment as a flow of 60 L/min develops a maximum PEEP of about 5 cmH 2 O.…”

Protective mechanics for successful extubation in invasive mechanical ventilation. Literature review

“…Por último, Yasuda et al 13 llevaron a cabo una revisión sistemática de la literatura con la intención de observar la efectividad de las diversas estrategias de soporte a la ventilación anteriormente propuestas (NIMV, HFNC y COT) sobre la reducción del riesgo de reintubación y de fallo respiratorio post-extubación en las primeras 72 horas tras la retirada del tubo endotraqueal 13 .…”

“…Los resultados evidenciaron que la HFNC, así como la NIMV, implican un menor riesgo de reintubación en comparación con la COT: RR 0.54 (IC 95% 0.32-0.89) frente a RR 0.55 (IC 95% 0.30 -1.00), respectivamente 13 . En relación al fallo respiratorio agudo post-extubación, los resultados obtenidos no fueron significativos.…”

“…En relación al fallo respiratorio agudo post-extubación, los resultados obtenidos no fueron significativos. Tanto la HFNC como la NIMV presentaron un riesgo ligeramente menor de desarrollar este evento adverso con respecto a la COT: RR 0.66 (IC 95% 0.43 -1.02) y RR 0.86 (IC 95% 0.54 -1.38), respectivamente 13 .…”

“…Del mismo modo, cabe resaltar que se incluyeron algunos estudios en los que había una proporción considerable de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y de pacientes que se encontraban en situación de post-operatorio; aunque, en ningún caso, este tipo de pacientes superó el 50% de la composición de las poblaciones de estudio 13 .…”