TY - JOUR
T1 - High-Flow Nasal Cannula in the Immediate Postoperative Period
T2 - A Systematic Review and Meta-analysis
AU - Chaudhuri, Dipayan
AU - Granton, David
AU - Wang, Dominic Xiang
AU - Burns, Karen E.A.
AU - Helviz, Yigal
AU - Einav, Sharon
AU - Trivedi, Vatsal
AU - Mauri, Tommaso
AU - Ricard, Jean Damien
AU - Mancebo, Jordi
AU - Frat, Jean Pierre
AU - Jog, Sameer
AU - Hernandez, Gonzalo
AU - Maggiore, Salvatore M.
AU - Mbuagbaw, Lawrence
AU - Hodgson, Carol L.
AU - Jaber, Samir
AU - Goligher, Ewan C.
AU - Brochard, Laurent
AU - Rochwerg, Bram
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: T. M. received personal fees from Drager Mindray and Fisher & Paykel Healthcare unrelated to the present work. J. D. R. received travel expenses coverage from Fisher & Paykel Healthcare to attend scientific meetings, and Fisher & Paykel Healthcare provided support for the ongoing High Flow ACRF trial (ClinicalTrials.gov, NCT03406572) for which he is the contact. J. M. received personal fees from Faron Pharmaceuticals, Janssen Pharmaceutica, and Medtronic plc; ALung Technologies, Inc, and Fisher & Paykel Healthcare provided medical equipment for multicenter trials (high-flow nasal oxygen therapy and extracorporeal carbon dioxide removal, respectively); Imtmedical AG provided travel and hotel expenses to attend a meeting. J. P. F. received personal fess from Fisher & Paykel Healthcare for lectures, reimbursement of travels and accommodations for medical meetings, and equipment for centers for clinical studies. G. H. received personal fees and travel expenses from Fisher & Paykel Healthcare. S. M. M. was the principal investigator of the RINO trial (ClinicalTrials.gov, NCT02107183), which was supported by Fisher & Paykel Healthcare, and received lecture fees from Dräger Medical sro and GE Healthcare . C. L. H. is supported by an Australian Heart Foundation fellowship and a National Health and Medical Research Council Investigator Grant GTN1173271. S. Jaber reports receiving consulting fees from Baxter International Inc, Dräger Medical sro, Fisher & Paykel Healthcare, Fresenius Medical Care AG & Co (Xenios AG), and Medtronic plc. B. R. is supported by a Hamilton Health Sciences Research Early Career Award. None declared (D. C., D. G., D. X. W., K. E. A. B., Y. H., S. E., V. T., S. Jog, L. M., E. C. G., L. B.).
Funding Information:
Author contributions: D. C. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. D. C. D. G. D. X. W. K. E. A. B. Y. H. S. E. and B. R. contributed substantially to study design, data collection and data analysis. All authors helped with study interpretation, writing and editing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: T. M. received personal fees from Drager Mindray and Fisher & Paykel Healthcare unrelated to the present work. J. D. R. received travel expenses coverage from Fisher & Paykel Healthcare to attend scientific meetings, and Fisher & Paykel Healthcare provided support for the ongoing High Flow ACRF trial (ClinicalTrials.gov, NCT03406572) for which he is the contact. J. M. received personal fees from Faron Pharmaceuticals, Janssen Pharmaceutica, and Medtronic plc; ALung Technologies, Inc, and Fisher & Paykel Healthcare provided medical equipment for multicenter trials (high-flow nasal oxygen therapy and extracorporeal carbon dioxide removal, respectively); Imtmedical AG provided travel and hotel expenses to attend a meeting. J. P. F. received personal fess from Fisher & Paykel Healthcare for lectures, reimbursement of travels and accommodations for medical meetings, and equipment for centers for clinical studies. G. H. received personal fees and travel expenses from Fisher & Paykel Healthcare. S. M. M. was the principal investigator of the RINO trial (ClinicalTrials.gov, NCT02107183), which was supported by Fisher & Paykel Healthcare, and received lecture fees from Dr?ger Medical sro and GE Healthcare. C. L. H. is supported by an Australian Heart Foundation fellowship and a National Health and Medical Research Council Investigator Grant GTN1173271. S. Jaber reports receiving consulting fees from Baxter International Inc, Dr?ger Medical sro, Fisher & Paykel Healthcare, Fresenius Medical Care AG & Co (Xenios AG), and Medtronic plc. B. R. is supported by a Hamilton Health Sciences Research Early Career Award. None declared (D. C. D. G. D. X. W. K. E. A. B. Y. H. S. E. V. T. S. Jog, L. M. E. C. G. L. B.). Other contributions: This manuscript was written as an initiative of the Pleural Pressure Working Group (https://www.plugwgroup.org), a working group of the Acute Respiratory Failure section of the European Society of Intensive Care Medicine. Additional information: The e-Figures and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Publisher Copyright:
© 2020 American College of Chest Physicians
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Background: Studies have demonstrated that high-flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared with conventional oxygen therapy (COT). However, the data examining routine HFNC use in the immediate postoperative period are less clear. Research Question: Is routine HFNC use superior to COT or noninvasive ventilation (NIV) use in preventing intubation in patients postoperatively? Study Design and Methods: We comprehensively searched databases (PubMed, Embase, Web of Science) to identify randomized controlled trials (RCTs) that compared the effect of HFNC use with that of COT or NIV in the immediate postoperative period on reintubation, escalation of respiratory support, hospital mortality, ICU and hospital length of stay (LOS), postoperative hypoxemia, and treatment complications. We assessed individual study risk of bias (RoB) by using the revised Cochrane RoB 2 tool and rated certainty in outcomes by using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: We included 11 RCTs enrolling 2,201 patients. Ten compared HFNC with COT and one with NIV. Compared with COT use, HFNC use in the postoperative period was associated with a lower reintubation rate (relative risk [RR], 0.32; 95% CI, 0.12-0.88; absolute risk reduction [ARR], 2.9%; moderate certainty) and decreased escalation of respiratory support (RR, 0.54; 95% CI, 0.31-0.94; ARR, 5.8%; very low certainty). Post hoc subgroup analysis suggested that this effect was driven by patients who were obese and/or at high risk (subgroup differences, P = .06). We did not find differences in any of the other stated outcomes between HFNC and COT. HFNC was also no different from NIV in reintubation rate, respiratory therapy failure, or ICU LOS. Interpretation: With evidence of moderate certainty, prophylactic HFNC reduces reintubation and escalation of respiratory support compared with COT in the immediate postoperative period after cardiothoracic surgery. This effect is likely driven by patients who are at high risk and/or obese. These findings support postoperative prophylactic HFNC use in the patients who are at high risk and/or obese undergoing cardiothoracic surgery.
AB - Background: Studies have demonstrated that high-flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared with conventional oxygen therapy (COT). However, the data examining routine HFNC use in the immediate postoperative period are less clear. Research Question: Is routine HFNC use superior to COT or noninvasive ventilation (NIV) use in preventing intubation in patients postoperatively? Study Design and Methods: We comprehensively searched databases (PubMed, Embase, Web of Science) to identify randomized controlled trials (RCTs) that compared the effect of HFNC use with that of COT or NIV in the immediate postoperative period on reintubation, escalation of respiratory support, hospital mortality, ICU and hospital length of stay (LOS), postoperative hypoxemia, and treatment complications. We assessed individual study risk of bias (RoB) by using the revised Cochrane RoB 2 tool and rated certainty in outcomes by using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: We included 11 RCTs enrolling 2,201 patients. Ten compared HFNC with COT and one with NIV. Compared with COT use, HFNC use in the postoperative period was associated with a lower reintubation rate (relative risk [RR], 0.32; 95% CI, 0.12-0.88; absolute risk reduction [ARR], 2.9%; moderate certainty) and decreased escalation of respiratory support (RR, 0.54; 95% CI, 0.31-0.94; ARR, 5.8%; very low certainty). Post hoc subgroup analysis suggested that this effect was driven by patients who were obese and/or at high risk (subgroup differences, P = .06). We did not find differences in any of the other stated outcomes between HFNC and COT. HFNC was also no different from NIV in reintubation rate, respiratory therapy failure, or ICU LOS. Interpretation: With evidence of moderate certainty, prophylactic HFNC reduces reintubation and escalation of respiratory support compared with COT in the immediate postoperative period after cardiothoracic surgery. This effect is likely driven by patients who are at high risk and/or obese. These findings support postoperative prophylactic HFNC use in the patients who are at high risk and/or obese undergoing cardiothoracic surgery.
KW - high-flow nasal cannula
KW - meta-analysis
KW - postoperative
UR - http://www.scopus.com/inward/record.url?scp=85093946414&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.06.038
DO - 10.1016/j.chest.2020.06.038
M3 - Review Article
C2 - 32615190
AN - SCOPUS:85093946414
VL - 158
SP - 1934
EP - 1946
JO - Chest
JF - Chest
SN - 0012-3692
IS - 5
ER -