The efficacy of high flow nasal cannula oxygen therapy in preventing postoperative respiratory failure:a Meta-analysis / 中国中西医结合急救杂志

ABSTRACT

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.