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High-Flow Nasal Cannula Versus Noninvasive Ventilation in Patients With COVID-19.
Beran, Azizullah; Srour, Omar; Malhas, Saif-Eddin; Mhanna, Mohammed; Ayesh, Hazem; Sajdeya, Omar; Musallam, Rami; Khokher, Waleed; Kalifa, Muhamad; Srour, Khaled; Assaly, Ragheb.
  • Beran A; Department of Internal Medicine, University of Toledo, Toledo, Ohio. Azizullah.Beran@utoledo.edu.
  • Srour O; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Malhas SE; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Mhanna M; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Ayesh H; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Sajdeya O; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Musallam R; St. Vincent Charity Medical Center, Cleveland, Ohio.
  • Khokher W; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Kalifa M; Department of Internal Medicine, University of Toledo, Toledo, Ohio.
  • Srour K; Department of Critical Care Medicine, Henry Ford Health System, Detroit, Michigan.
  • Assaly R; Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, Ohio.
Respir Care ; 67(9): 1177-1189, 2022 09.
Article in English | MEDLINE | ID: covidwho-1924460
ABSTRACT

BACKGROUND:

High-flow nasal cannula (HFNC) oxygen and noninvasive ventilation (NIV) have been widely used in patients with acute hypoxic respiratory failure (AHRF) due to COVID-19. However, the impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. Therefore, we performed this meta-analysis to evaluate the effect of HFNC versus NIV in COVID-19-related AHRF.

METHODS:

Several electronic databases were searched through February 10, 2022, for eligible studies comparing HFNC and NIV in COVID-19-related AHRF. Our primary outcome was intubation. The secondary outcomes were mortality, hospital length of stay (LOS), and PaO2 /FIO2 changes. Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% CI were obtained using a random-effect model. Prediction intervals were calculated to indicate the variance in outcomes that would be expected if new studies were conducted in the future.

RESULTS:

Nineteen studies involving 3,606 subjects (1,880 received HFNC and 1,726 received NIV) were included. There were no differences in intubation (RR 1.01 [95% CI 0.85-1.20], P = .89) or LOS (MD 0.38 d [95% CI -0.61 to 1.37], P = .45) between groups, with consistent results on the subgroup of randomized controlled trials (RCTs). Mortality was lower in NIV (RR 0.81 [95% CI 0.66-0.98], P = .03). However, the prediction interval was 0.41-1.59, and subgroup analysis of RCTs showed no difference in mortality between groups. There was a greater improvement in PaO2 /FIO2 with NIV (MD 22.80 [95% CI 5.30-40.31], P = .01).

CONCLUSIONS:

Our study showed that despite the greater improvement in PaO2 /FIO2 with NIV, intubation rates and LOS were similar between HFNC and NIV. Although mortality was lower with HFNC than NIV, the prediction interval included the null value, and there was no difference in mortality between HFNC and NIV on a subgroup of RCTs. Future large-scale RCTs are necessary to support our findings.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Noninvasive Ventilation / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews Limits: Humans Language: English Journal: Respir Care Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Respiratory Insufficiency / Noninvasive Ventilation / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews Limits: Humans Language: English Journal: Respir Care Year: 2022 Document Type: Article