Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis

Dipayan Chaudhuri; David Granton; Dominic Xiang Wang; Sharon Einav; Yigal Helviz; Tommaso Mauri; Jean-Damien Ricard; Jordi Mancebo; Jean-Pierre Frat; Sameer Jog; Gonzalo Hernandez; Salvatore M Maggiore; Carol Hodgson; Samir Jaber; Laurent Brochard; Karen E A Burns; Bram Rochwerg

doi:10.1097/CCM.0000000000004217

Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis

Crit Care Med. 2020 Apr;48(4):571-578. doi: 10.1097/CCM.0000000000004217.

Authors

Dipayan Chaudhuri¹, David Granton¹, Dominic Xiang Wang², Sharon Einav^{3

4}, Yigal Helviz³, Tommaso Mauri^{5

6}, Jean-Damien Ricard^{7

8}, Jordi Mancebo⁹, Jean-Pierre Frat^{10

11

12}, Sameer Jog¹³, Gonzalo Hernandez¹⁴, Salvatore M Maggiore¹⁵, Carol Hodgson¹⁶, Samir Jaber¹⁷, Laurent Brochard¹⁸, Karen E A Burns¹⁸, Bram Rochwerg^{1

19}

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
² Schulich School of Medicine, Western University, London, ON, Canada.
³ General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
⁴ Faculty of Medicine, Hebrew University, Jerusalem, Israel.
⁵ Dipartimento di fisopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Milan, Italy.
⁶ Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
⁷ Assistance Publique-Hôpital de Paris, Service de Réanimation Médico-chirurgicale, Hôpital Louis Mourier, Colombes, France.
⁸ Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.
⁹ Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.
¹⁰ CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
¹¹ INSERM, CIC-1402, équipe ALIVE, Poitiers, France.
¹² Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France.
¹³ Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India.
¹⁴ Intensive Care Unit, Hospital Infanta Sofía, Madrid, Spain.
¹⁵ Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, AND Department of Anesthesiology and Critical Care, SS. Annunziata Hospital, Chieti, Italy.
¹⁶ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹⁷ University Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France.
¹⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 32205604
DOI: 10.1097/CCM.0000000000004217

Abstract

Objective: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.

Data sources: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).

Study selection: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.

Data extraction: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, PaO2 before and after intubation, PaCO2 after intubation, ICU length of stay, and short-term mortality.

Data synthesis: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68-1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71-1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), PaO2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or PaO2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation PaCO2, ICU length of stay, or 28-day mortality.

Conclusions: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.

Trial registration: ClinicalTrials.gov NCT02107183.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cannula*
Humans
Hypoxia / therapy
Intensive Care Units
Intubation, Intratracheal / methods
Noninvasive Ventilation / methods*
Oxygen / administration & dosage*
Oxygen Inhalation Therapy / methods*
Respiratory Insufficiency / therapy

Substances

Oxygen

Associated data

ClinicalTrials.gov/NCT02107183