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

• Published in: International journal of chronic obstructive pulmonary disease Vol. 17; pp. 1987 - 1999
• Main Authors: Feng, Zhouzhou, Zhang, Lu, Yu, Haichuan, Su, Xiaojie, Shuai, Tiankui, Zhu, Lei, Chen, De, Liu, Jian
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2022; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: acute exacerbation of chronic obstructive pulmonary disease; Airway Extubation - adverse effects; Analysis; Bias; Cannula - adverse effects; Care and treatment; China; Chronic illnesses; Chronic obstructive pulmonary disease; Confidence intervals; Evidence-based medicine; Extubation; Health aspects; Humans; Hypercapnia - diagnosis; Hypercapnia - etiology; Hypercapnia - therapy; Lung diseases, Obstructive; Meta-analysis; Mortality; nasal high-flow oxygen therapy; non-invasive ventilation; Noninvasive Ventilation - adverse effects; Noninvasive Ventilation - methods; Oxygen; Oxygen Inhalation Therapy - adverse effects; Oxygen Inhalation Therapy - methods; Oxygen therapy; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - etiology; Pulmonary Disease, Chronic Obstructive - therapy; Randomized Controlled Trials as Topic; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Review; Software; Statistical analysis; Systematic review; Ventilators; Weaning; China; meta-analysis; nasal high-flow oxygen therapy; acute exacerbation of chronic obstructive pulmonary disease; non-invasive ventilation
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S375107

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. 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. 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. 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.