Author/Authors :
Huang, Cheng-Chieh Department of Emergency Medicine - Changhua Christian Hospital - Changhua - Taiwan - Department of Biological Science and Technology - National Chiao Tung University - Hsinchu - Taiwan , Lan, Hao-Min Department of Education - Kaohsiung Chang Gung Memorial Hospital - Chang Gung University College of Medicine - Taoyuan, Taiwan , Li, Chao-Jui Department of Emergency Medicine - Kaohsiung Chang Gung Memorial Hospital - Chang Gung University College of Medicine - Kaohsiung - Taiwan - Department of Leisure and Sports Management - Cheng Shiu University - Kaohsiung - Taiwan , Lee, Tsung-Han Department of Emergency Medicine - Changhua Christian Hospital - Changhua - Taiwan - Department of Biological Science and Technology - National Chiao Tung University - Hsinchu - Taiwan , Chen, Wen-Liang Department of Biological Science and Technology - National Chiao Tung University - Hsinchu - Taiwan , Lei, Wei-Yuan Department of Emergency Medicine - Changhua Christian Hospital - Changhua - Taiwan , Hsieh, Pei-You Department of Emergency Medicine - Changhua Christian Hospital - Changhua - Taiwan , Yang, Mei-Chueh Department of Emergency Medicine - Changhua Christian Hospital - Changhua - Taiwan , Chou, Chu-Chung School of Medicine - Kaohsiung Medical University - Kaohsiung - Taiwan - School of Medicine - Chung Shan Medical University - Taichung, Taiwan , Wu, Han-Ping Department of Pediatric Emergency Medicine - Children Hospital - China Medical University - Taichung - Taiwan - Department of Medicine - School of Medicine - China Medical University - Taichung - Taiwan - Department of Medical Research - Children’s Hospital - China Medical University - Taichung - Taiwan , Syue, Yuan-Jhen Department of Anaesthesiology - Kaohsiung Chang Gung Memorial Hospital - Chang Gung University College of Medicine - Kaohsiung - Taiwan
Abstract :
Objective. To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy (COT) or noninvasive ventilation (NIV) for the treatment of acute respiratory failure (ARF) in emergency departments (EDs). Method.
We comprehensively searched 3 databases (PubMed, EMBASE, and the Cochrane Library) for articles published from database
inception to 12 July 2019. -is study included only randomized controlled trials (RCTs) that were conducted in EDs and compared
HFNC therapy with COT or NIV. -e primary outcome was the intubation rate. -e secondary outcomes were the mortality rate,
intensive care unit (ICU) admission rate, ED discharge rate, need for escalation, length of ED stay, length of hospital stay, and
patient dyspnea and comfort scores. Result. Five RCTs (n � 775) were included. -ere was a decreasing trend regarding the
application of HFNC therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% CI,
0.26–1.09; p � 0.08; I
2 � 0%). We found that compared with patients who underwent COT, those who underwent HFNC therapy
had a reduced need for escalation (RR, 0.41; 95% CI, 0.22–0.78; p � 0.006; I
2 � 0%), reduced dyspnea scores (MD − 0.82, 95% CI
− 1.45 to − 0.18), and improved comfort (SMD − 0.76 SD, 95% CI − 1.01 to − 0.51). Compared with the COT group, the HFNC
therapy group had a similar mortality rate (RR, 1.25; 95% CI, 0.79–1.99; p � 0.34; I
2 � 0%), ICU admission rate (RR, 1.11; 95% CI,
0.58–2.12; p � 0.76; I
2 � 0%), ED discharge rate (RR, 1.04; 95% CI, 0.63–1.72; p � 0.87; I
2 � 0%), length of ED stay (MD 1.66, 95%
CI − 0.95 to 4.27), and hospital stay (MD 0.9, 95% CI − 2.06 to 3.87). Conclusion. Administering HFNC therapy in ARF patients in
EDs might decrease the intubation rate compared with COT. In addition, it can decrease the need for escalation, decrease the patient’s dyspnea level, and increase the patient’s comfort level compared with COT.
Keywords :
High-Flow Nasal Cannula , Acute Respiratory Failure , Patients , Emergency Department , Meta-Analysis Study
