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High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission.
Agarwal, Arnav; Basmaji, John; Muttalib, Fiona; Granton, David; Chaudhuri, Dipayan; Chetan, Devin; Hu, Malini; Fernando, Shannon M; Honarmand, Kimia; Bakaa, Layla; Brar, Sonia; Rochwerg, Bram; Adhikari, Neill K; Lamontagne, Francois; Murthy, Srinivas; Hui, David S C; Gomersall, Charles; Mubareka, Samira; Diaz, Janet V; Burns, Karen E A; Couban, Rachel; Ibrahim, Quazi; Guyatt, Gordon H; Vandvik, Per O.
  • Agarwal A; Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Basmaji J; Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
  • Muttalib F; Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
  • Granton D; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Chaudhuri D; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Chetan D; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
  • Hu M; Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada.
  • Fernando SM; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Honarmand K; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Bakaa L; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Brar S; Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
  • Rochwerg B; Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, ON, Canada.
  • Adhikari NK; Honours Life Sciences Program, Faculty of Science, McMaster University, Hamilton, ON, Canada.
  • Lamontagne F; School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA.
  • Murthy S; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Hui DSC; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Gomersall C; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Mubareka S; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Diaz JV; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • Burns KEA; Université de Sherbrooke, Sherbrooke, Canada.
  • Couban R; Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.
  • Ibrahim Q; BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
  • Guyatt GH; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
  • Vandvik PO; Stanley Ho, Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
Can J Anaesth ; 67(9): 1217-1248, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1536371
Semantic information from SemMedBD (by NLM)
1. Nasal Cannula TREATS Acute hypoxemic respiratory failure
Subject
Nasal Cannula
Predicate
TREATS
Object
Acute hypoxemic respiratory failure
2. Acute hypoxemic respiratory failure PROCESS_OF Patients
Subject
Acute hypoxemic respiratory failure
Predicate
PROCESS_OF
Object
Patients
3. Disease PROCESS_OF Patients
Subject
Disease
Predicate
PROCESS_OF
Object
Patients
4. Nasal Cannula TREATS Disease
Subject
Nasal Cannula
Predicate
TREATS
Object
Disease
5. Nasal Cannula TREATS Patients
Subject
Nasal Cannula
Predicate
TREATS
Object
Patients
6. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
7. Nasal Cannula TREATS Critical Illness
Subject
Nasal Cannula
Predicate
TREATS
Object
Critical Illness
8. Conventional Treatment TREATS Critical Illness
Subject
Conventional Treatment
Predicate
TREATS
Object
Critical Illness
9. Conventional Treatment TREATS Acute hypoxemic respiratory failure
Subject
Conventional Treatment
Predicate
TREATS
Object
Acute hypoxemic respiratory failure
10. Conventional Treatment USES oxygen
Subject
Conventional Treatment
Predicate
USES
Object
oxygen
11. Nasal Cannula compared_with Conventional Treatment
Subject
Nasal Cannula
Predicate
compared_with
Object
Conventional Treatment
12. Conventional Treatment TREATS Patients
Subject
Conventional Treatment
Predicate
TREATS
Object
Patients
13. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
14. Respiration PROCESS_OF Patients
Subject
Respiration
Predicate
PROCESS_OF
Object
Patients
15. Nasal Cannula TREATS Patient Physiological Condition
Subject
Nasal Cannula
Predicate
TREATS
Object
Patient Physiological Condition
16. Conventional Treatment TREATS Patient Physiological Condition
Subject
Conventional Treatment
Predicate
TREATS
Object
Patient Physiological Condition
17. Nasal Cannula TREATS Acute hypoxemic respiratory failure
Subject
Nasal Cannula
Predicate
TREATS
Object
Acute hypoxemic respiratory failure
18. Acute hypoxemic respiratory failure PROCESS_OF Patients
Subject
Acute hypoxemic respiratory failure
Predicate
PROCESS_OF
Object
Patients
19. Disease PROCESS_OF Patients
Subject
Disease
Predicate
PROCESS_OF
Object
Patients
20. Nasal Cannula TREATS Disease
Subject
Nasal Cannula
Predicate
TREATS
Object
Disease
21. Nasal Cannula TREATS Patients
Subject
Nasal Cannula
Predicate
TREATS
Object
Patients
22. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
23. Nasal Cannula TREATS Critical Illness
Subject
Nasal Cannula
Predicate
TREATS
Object
Critical Illness
24. Conventional Treatment TREATS Critical Illness
Subject
Conventional Treatment
Predicate
TREATS
Object
Critical Illness
25. Conventional Treatment TREATS Acute hypoxemic respiratory failure
Subject
Conventional Treatment
Predicate
TREATS
Object
Acute hypoxemic respiratory failure
26. Conventional Treatment USES oxygen
Subject
Conventional Treatment
Predicate
USES
Object
oxygen
27. Nasal Cannula compared_with Conventional Treatment
Subject
Nasal Cannula
Predicate
compared_with
Object
Conventional Treatment
28. Conventional Treatment TREATS Patients
Subject
Conventional Treatment
Predicate
TREATS
Object
Patients
29. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
30. Respiration PROCESS_OF Patients
Subject
Respiration
Predicate
PROCESS_OF
Object
Patients
31. Nasal Cannula TREATS Patient Physiological Condition
Subject
Nasal Cannula
Predicate
TREATS
Object
Patient Physiological Condition
32. Conventional Treatment TREATS Patient Physiological Condition
Subject
Conventional Treatment
Predicate
TREATS
Object
Patient Physiological Condition
ABSTRACT

PURPOSE:

We conducted two World Health Organization-commissioned reviews to inform use of high-flow nasal cannula (HFNC) in patients with coronavirus disease (COVID-19). We synthesized the evidence regarding efficacy and safety (review 1), as well as risks of droplet dispersion, aerosol generation, and associated transmission (review 2) of viral products. SOURCE Literature searches were performed in Ovid MEDLINE, Embase, Web of Science, Chinese databases, and medRxiv. Review 1 we synthesized results from randomized-controlled trials (RCTs) comparing HFNC to conventional oxygen therapy (COT) in critically ill patients with acute hypoxemic respiratory failure. Review 2 we narratively summarized findings from studies evaluating droplet dispersion, aerosol generation, or infection transmission associated with HFNC. For both reviews, paired reviewers independently conducted screening, data extraction, and risk of bias assessment. We evaluated certainty of evidence using GRADE methodology. PRINCIPAL

FINDINGS:

No eligible studies included COVID-19 patients. Review 1 12 RCTs (n = 1,989 patients) provided low-certainty evidence that HFNC may reduce invasive ventilation (relative risk [RR], 0.85; 95% confidence interval [CI], 0.74 to 0.99) and escalation of oxygen therapy (RR, 0.71; 95% CI, 0.51 to 0.98) in patients with respiratory failure. Results provided no support for differences in mortality (moderate certainty), or in-hospital or intensive care length of stay (moderate and low certainty, respectively). Review 2 four studies evaluating droplet dispersion and three evaluating aerosol generation and dispersion provided very low certainty evidence. Two simulation studies and a crossover study showed mixed findings regarding the effect of HFNC on droplet dispersion. Although two simulation studies reported no associated increase in aerosol dispersion, one reported that higher flow rates were associated with increased regions of aerosol density.

CONCLUSIONS:

High-flow nasal cannula may reduce the need for invasive ventilation and escalation of therapy compared with COT in COVID-19 patients with acute hypoxemic respiratory failure. This benefit must be balanced against the unknown risk of airborne transmission.
RéSUMé OBJECTIF Nous avons réalisé deux comptes rendus sur commande de l'Organisation mondiale de la santé pour guider l'utilisation de canules nasales à haut débit (CNHD) chez les patients ayant contracté le coronavirus (COVID-19). Nous avons synthétisé les données probantes concernant leur efficacité et leur innocuité (compte rendu 1), ainsi que les risques de dispersion des gouttelettes, de génération d'aérosols, et de transmission associée d'éléments viraux (compte rendu 2). SOURCE Des recherches de littérature ont été réalisées dans les bases de données Ovid MEDLINE, Embase, Web of Science, ainsi que dans les bases de données chinoises et medRxiv. Compte rendu 1  nous avons synthétisé les résultats d'études randomisées contrôlées (ERC) comparant les CNHD à une oxygénothérapie conventionnelle chez des patients en état critique atteints d'insuffisance respiratoire hypoxémique aiguë. Compte rendu 2  nous avons résumé sous forme narrative les constatations d'études évaluant la dispersion de gouttelettes, la génération d'aérosols ou la transmission infectieuse associées aux CNHD. Pour les deux comptes rendus, des réviseurs appariés ont réalisé la sélection des études, l'extraction des données et l'évaluation du risque de biais de manière indépendante. Nous avons évalué la certitude des données probantes en nous fondant sur la méthodologie GRADE. CONSTATATIONS PRINCIPALES Aucune étude éligible n'incluait de patients atteints de COVID-19. Compte rendu 1  12 ERC (n = 1989 patients) ont fourni des données probantes de certitude faible selon lesquelles les CNHD réduiraient la ventilation invasive (risque relatif [RR], 0,85; intervalle de confiance [IC] 95 %, 0,74 à 0,99) et l'intensification de l'oxygénothérapie (RR, 0,71; IC 95 %, 0,51 à 0,98) chez les patients atteints d'insuffisance respiratoire. Les résultats n'ont pas démontré de différences en matière de mortalité (certitude modérée), ni de durée du séjour hospitalier ou à l'unité des soins intensifs (certitude modérée et faible, respectivement). Compte rendu 2  quatre études évaluant la dispersion de gouttelettes et trois évaluant la génération et la dispersion d'aérosols ont fourni des données probantes de très faible certitude. Deux études de simulation et une étude croisée ont donné des résultats mitigés quant à l'effet des CNHD sur la dispersion des gouttelettes. Bien que deux études de simulation n'aient rapporté aucune augmentation associée concernant la dispersion d'aérosols, l'une a rapporté que des taux de débit plus élevés étaient associés à des régions à densité d'aérosols élevée plus grandes.

CONCLUSION:

Les canules nasales à haut débit pourraient réduire la nécessité de recourir à la ventilation invasive et l'escalade des traitements par rapport à l'oxygénothérapie conventionnelle chez les patients atteints de COVID-19 souffrant d'insuffisance respiratoire hypoxémique aiguë. Cet avantage doit être soupesé contre le risque inconnu de transmission atmosphérique.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Pneumonia, Viral / Respiratory Insufficiency / Coronavirus Infections Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials / Reviews / Risk factors / Systematic review Limits: Humans Language: English Journal: Can J Anaesth Journal subject: Anesthesiology Year: 2020 Document Type: Article Affiliation country: S12630-020-01740-2

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Pneumonia, Viral / Respiratory Insufficiency / Coronavirus Infections Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials / Reviews / Risk factors / Systematic review Limits: Humans Language: English Journal: Can J Anaesth Journal subject: Anesthesiology Year: 2020 Document Type: Article Affiliation country: S12630-020-01740-2