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Meta-Analysis
. 2018 Oct-Dec;30(4):487-495.
doi: 10.5935/0103-507X.20180070.

The effects of high-flow nasal cannula on intubation and re-intubation in critically ill patients: a systematic review, meta-analysis and trial sequential analysis

[Article in Portuguese, English]
Rafael Ladeira Rosa Bocchile  1 , Denise Carnieli Cazati  1 , Karina Tavares Timenetsky  1 , Ary Serpa Neto  1   2
Affiliations
Meta-Analysis

The effects of high-flow nasal cannula on intubation and re-intubation in critically ill patients: a systematic review, meta-analysis and trial sequential analysis

[Article in Portuguese, English]
Rafael Ladeira Rosa Bocchile et al. Rev Bras Ter Intensiva. 2018 Oct-Dec.

Abstract
in English, Portuguese

Objective: To evaluate the efficacy of high-flow nasal cannula in the prevention of intubation and re-intubation in critically ill patients compared to conventional oxygen therapy or noninvasive ventilation.

Methods: This systematic review was performed through an electronic database search of articles published from 1966 to April 2018. The primary outcome was the need for intubation or re-intubation. The secondary outcomes were therapy escalation, mortality at the longest follow-up, hospital mortality and the need for noninvasive ventilation.

Results: Seventeen studies involving 3,978 patients were included. There was no reduction in the need for intubation or re-intubation with high-flow nasal cannula (OR 0.72; 95%CI 0.52 - 1.01; p = 0.056). There was no difference in the need for therapy escalation (OR 0.80, 95% CI 0.59 - 1.08, p = 0.144), mortality at the longest follow-up (OR 0.94; 95%CI 0.70 - 1.25; p = 0.667), hospital mortality (OR 0.84; 95%CI 0.56 - 1.26; p = 0.391) or noninvasive ventilation (OR 0.64, 95%CI 0.39 - 1.05, p = 0.075). In the trial sequential analysis, the number of events included was lower than the optimal information size with a global type I error > 0.05.

Conclusion: In the present study and setting, high-flow nasal cannula was not associated with a reduction of the need for intubation or re-intubation in critically ill patients.

Objetivo: Avaliar a eficácia do cateter nasal de alto fluxo na prevenção de intubação e reintubação de pacientes críticos em comparação com oxigenoterapia convencional ou ventilação não invasiva.

Métodos: Esta revisão sistemática foi realizada por meio de busca eletrônica em bancos de dados incluindo trabalhos publicados entre 1966 e abril de 2018. O desfecho primário foi a necessidade de intubação ou reintubação. Os desfechos secundários foram escalonamento de terapia, mortalidade no seguimento mais longo, mortalidade hospitalar e necessidade de ventilação não invasiva.

Resultados: Dezessete estudos com 3.978 pacientes foram incluídos. Não houve redução na necessidade de intubação ou reintubação (OR 0,72; IC95% 0,52 - 1,01; p = 0,056). Não houve diferença no escalonamento de terapia (OR 0,80; IC95% 0,59 - 1,08; p = 0,144), na mortalidade no seguimento mais longo (OR 0,94; IC95% 0,70 - 1,25; p = 0,667), na mortalidade hospitalar (OR 0,84; IC95% 0,56 - 1,26; p = 0,391) ou na necessidade de ventilação não invasiva (OR 0,64; IC95% 0,39 - 1,05, p = 0,075). Na análise sequencial de ensaios, o número de eventos incluídos foi menor que o tamanho ótimo de informação, com erro tipo I global > 0,05.

Conclusão: No presente estudo e no cenário avaliado, o cateter nasal de alto fluxo não foi associado com redução na necessidade de intubação ou reintubação em pacientes críticos.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Forest plot comparing the effects of high-flow nasal cannula with the control group for the primary outcome (need for intubation or re-intubation).
Figure 3
Figure 3
Forest plot comparing the effects of high-flow nasal cannula with the control group for: (A) need for therapy escalation; (B) mortality at the longest follow-up; (C) hospital mortality; and (D) need for noninvasive ventilation.
Figure 4
Figure 4
Trial sequential analysis assessing the effect of high-flow nasal cannula in the primary outcome. The cumulative meta-analysis with 518 events (blue line) did not cross the efficacy boundary for the primary outcome (global type I error > 5%; purple line). The same was found when a more conservative boundary was used (red line).
See this image and copyright information in PMC

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