High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials.
Br J Anaesth
; 132(5): 936-944, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38307776
ABSTRACT
BACKGROUND:
Noninvasive methods of respiratory support, including noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO), are potential strategies to prevent progression to requirement for invasive mechanical ventilation in acute hypoxaemic respiratory failure. The COVID-19 pandemic provided an opportunity to understand the utility of noninvasive respiratory support among a homogeneous cohort of patients with contemporary management of acute respiratory distress syndrome. We performed a network meta-analysis of studies evaluating the efficacy of NIV (including CPAP) and HFNO, compared with conventional oxygen therapy (COT), in patients with COVID-19.METHODS:
PubMed, Embase, and the Cochrane library were searched in May 2023. Standard random-effects meta-analysis was used first to estimate all direct pairwise associations and the results from all studies were combined using frequentist network meta-analysis. Primary outcome was treatment failure, defined as discontinuation of HFNO, NIV, or COT despite progressive disease. Secondary outcome was mortality.RESULTS:
We included data from eight RCTs with 2302 patients, (756 [33%] assigned to COT, 371 [16%] to NIV, and 1175 [51%] to HFNO). The odds of treatment failure were similar for NIV (P=0.33) and HFNO (P=0.25), and both were similar to that for COT (reference category). The odds of mortality were similar for all three treatments (odds ratio for NIV vs COT 1.06 [0.46-2.44] and HFNO vs COT 0.97 [0.57-1.65]).CONCLUSIONS:
Noninvasive ventilation, high-flow nasal oxygen, and conventional oxygen therapy are comparable with regards to treatment failure and mortality in COVID-19-associated acute respiratory failure. PROSPERO REGISTRATION CRD42023426495.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Oxygen Inhalation Therapy
/
Respiratory Insufficiency
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Randomized Controlled Trials as Topic
/
Noninvasive Ventilation
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Network Meta-Analysis
/
COVID-19
Type of study:
Clinical_trials
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Br J Anaesth
Year:
2024
Type:
Article
Affiliation country:
United kingdom