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Meta-Analysis
. 2022 Aug 30:17:1987-1999.
doi: 10.2147/COPD.S375107. eCollection 2022.

High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhouzhou Feng  1 , Lu Zhang  1 , Haichuan Yu  1 , Xiaojie Su  1 , Tiankui Shuai  1 , Lei Zhu  1 , De Chen  1 , Jian Liu  1
Affiliations
Meta-Analysis

High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhouzhou Feng et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Objective: To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation.

Research methods: This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay.

Results: Eight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (-0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different.

Conclusion: According to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV.

Keywords: acute exacerbation of chronic obstructive pulmonary disease; meta-analysis; nasal high-flow oxygen therapy; non-invasive ventilation.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA (preferred reporting items for systematic reviews and meta-analysis) flow diagram.
Figure 2
Figure 2
Forest plot of reintubation rates, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.
Figure 3
Figure 3
Forest plot of mortality, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.
Figure 4
Figure 4
Forest plot of ICU length of stay, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.
Figure 5
Figure 5
Forest plot of complication rates, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.
See this image and copyright information in PMC

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