Meta-analysis of clinical efficacy of Helmet non-invasive ventilation and oxygen therapy on patients with hypoxemic respiratory failure / 中华危重病急救医学

ABSTRACT

Objective To systematically evaluate the clinical efficacies of Helmet non-invasive ventilation and oxygen therapy on patients with hypoxemic respiratory failure. Methods The randomized controlled trials (RCTs) for comparison of efficacy between Helmet non-invasive ventilation and oxygen therapy for treatment of patients with hypoxemic respiratory failure published by Wanfang database, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), PubMed, Embase, Cochrane Library and Web of Science were retrieved. The retrieval time was from the establishment of database to February 1st, 2019. The indexes of the study outcomes included oxygenation index, arterial partial pressure of carbon dioxide (PaCO2), endotracheal intubation rate, hospital mortality and intolerance rate. Literature search and data extraction was performed separately by two researchers. Quality assessment of literature was conducted according to the risk of bias criterion provided by Cochrane collaboration net. The extractive data were Meta-analyzed by RevMan 5.1.0. Funnel plot and Egger regression analysis was employed to detect publication bias. Results Six RCTs including 5 English studies and 1 Chinese study were selected. Finally, 547 patients were enrolled, with 270 patients in Helmet non-invasive ventilation group and 277 in oxygen therapy group. The study quality assessment revealed that the overall risk of bias was low, and no publication bias was detected by the funnel plot and Egger regression analysis. Meta-analysis showed that the oxygenation index in Helmet non-invasive ventilation group was significantly higher than that in oxygen therapy group [mean difference (MD) = 73.47, 95% confidence interval (95%CI) was 52.01 to 94.92, P = 0.000 01], and PaCO2 (MD = -2.46, 95%CI was -4.54 to -0.39, P = 0.02), endotracheal intubation rate [relative risk ratio (RR) = 0.38, 95%CI was 0.20 to 0.73, P = 0.004] and hospital mortality (RR = 0.35, 95%CI was 0.19 to 0.65, P = 0.000 8) in Helmet non-invasive ventilation group were significantly lower than those in oxygen therapy group. There was no significant difference in patient's intolerance between the two groups (RR = 2.38, 95%CI was 0.74 to 7.67, P = 0.15). Conclusion Compared with oxygen therapy, the Helmet non-invasive ventilation used for treatment of patients with hypoxemic respiratory failure can effectively improve the oxygenation index, decrease the PaCO2, reduce the endotracheal intubation rate and hospital mortality, and the patients are well tolerated to the Helmet method.