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Objective To evaluate the efficacy and safety of high flow nasal cannula (HFNC) oxygen therapy in preventing postoperative respiratory failure. Methods HFNC, nasal catheter high flow oxygen therapy, high flow nasal catheter oxygen therapy, high-flow nasal humidifiers and oxygen inhalers, and patients with postoperative respiratory failure were used as Chinese terms, and high flow nasal cannulae, high flow nasal cannulae oxygen therapy, nasal high flow, adult, postoperative respiratory failure were used as English terms to retrieve, a computer was used to retrieve already published all available randomized controlled trials (RCTs) about using HFNC therapy to prevent patients from the occurrence of postoperative respiratory failure; the search was carried out from PubMed in literature database of American National Library, the Cochrane Library, Holland Medical Abstract Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP database, Wanfang Database, China Biomedicine Database (CBM), and the articles were collected from the creation of various above databases to June 2017. The collected RCTs should be carefully read, and the inclusion or exclusion of an article should strictly follow the respective criteria. Two authors independently extracted data, conducted quality assessments , extract the elevation of respiratory support rate, hospital mortality and hospital length of stay, etc. Revman 5.3 software was used to carry out Meta analysis; funnel plots were applied to analyze the publication bias. Results Finally, after Meta analyses, 6 RCTs were included, involving 935 adult patients with existence of moderate to high risks of respiratory failure after the tube drawn out post-operationally, and there were 467 patients in the experimental group and 468 in control group. Compared with the control group, the escalation of respiratory support rate was reduced in the experimental group [odds ratio (OR) = 0.55, 95% confidence interval (95%CI) = 0.39 - 0.76, P = 0.000 3]; There were no statistical significant differences in improving hospital mortality (OR = 0.77, 95%CI = 0.17 - 3.48, P = 0.73) and shortening hospital length of stay [mean difference (MD) =-0.48, 95%CI = -1.37 - 0.41, P = 0.29] in the comparisons between the two groups, but experimental group tended to be the one with more advantage. The funnel plot analysis suggested that the publication bias was relatively low, because the distribution of the included articles was basically symmetrical. Conclusion Compared with COT, HFNC could reduce the escalation of respiratory support rate in patients with postoperative respiratory failure, although there were no statistical significant differences in hospital mortality and hospital length of stay between HFNC and COT, the advantage tends toward the HFNC.
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Conventional oxygen therapy (COT) is generally provided through a low flow rate device including a nasal cannula or facemask. Since the benefits of high-flow nasal cannula (HFNC) oxygen therapy in adults with acute respiratory failure (ARF) have firstly been demonstrated by Roca et al and because of its effectivity and comfort and good compliance, it has shown greater advantageous than COT and it has been increasingly used in adults with mild to moderate ARF and obtained very nice therapeutic effect. However, because of the specificity of emergency environment and the more complexity of HFNC system than COT, the use of HFNC in department of emergency is still controversial. Since HFNC system delivers oxygen by high-flow rate, the dilution of inspired oxygen concentration (FiO2) by room air can be maximally decreased, and the system can provide the highest flow rate up to 60 L/min, being greater than the patients' peak inspiration flow flow (PIF); the high flow rate can dilute the carbon dioxide (CO2) concentration in the anatomical dead space, and the above several factors can guarantee that HFNC may deliver 0.21-1.00 relatively constant FiO2. Therefore, HFNC as a new noninvasive supplemental oxygen therapy has been increasingly widely studied and used in the adult patients with ARF. In this article, we will review the HFNC physiological effects and its advances in application for adult patients in department of emergency.
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Objective To summarize the experiences of postoperative care of 7 patients with lung transplantation patients receiving high flow nasal cannulae oxygen therapy. Methods The key points to ensure the success of operation were oxygen therapy waiting for lung transplantation,sequential treatment after tracheal intubation, assisted by fiberoptic bronchoscopy, nasal high flow oxygen therapy failed to switch to non-invasive treatment or re intubation. Results All 7 patients got through the intensive care period successful. Conclusions High flow nasal cannulae can improve the comfort and compliance of lung transplant patients,and easy to operate.
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Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.