The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
Study Search and Selection
3. Results
3.1. Study Selection and Characteristics
3.2. Primary Outcomes
3.3. Secondary Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Reference | Random Sequence Generation | Allocation Concealment | Blinding of Participants and Personnel | Blinding of Outcome Assessment | Incomplete Outcome Data | Selective Reporting |
---|---|---|---|---|---|---|
Frat, 2016 | Low | High | High | High | Low | Low |
Lemiale, 2017 | Low | High | High | High | Low | Low |
Lemiale, 2015 | Low | High | High | High | Low | Low |
Azoulay, 2018 | Low | Low | High | High | Low | Low |
Reference | Representative of Exposed Cohort | Selection of Non-Exposed Cohort | Ascertainment of Exposure | Demonstration that Outcome Was Not Present at Start of Study | Comparability of Cohorts Based on Design and Analysis | Assessment of Outcome | Timing of Follow-Up | Adequate Follow-Up | Score |
---|---|---|---|---|---|---|---|---|---|
Mokart, 2015 | V | V | V | V | V | V | V | V | 8 |
Roca, 2015 | V | V | V | V | V | V | V | V | 8 |
Coudroy, 2016 | V | V | V | V | V | V | V | V | 8 |
Tu, 2017 | V | V | V | V | V | V | V | V | 8 |
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Study, Year | Study Design | Study Period | Study Site | Immunocompromised Condition | Inclusion Criteria |
---|---|---|---|---|---|
Tu, 2017 | Retrospective | 2011–2015 | Single tertiary mixed ICU in China | Renal transplant | RR > 25/min, PaO2/FiO2 ≤ 200 mm Hg, PaCO2 ≤ 45 mm Hg |
Coudroy, 2016 | Retrospective | 2007–2014 | Single tertiary medical ICU in France | Hematologic or solid cancer, stem or solid organ transplantation, steroid, cytotoxic drug, AIDS | RR > 25/min, sign of respiratory distress, PaO2/FiO2 ≤ 300 mm Hg |
Frat, 2016 | Post-hoc analysis of RCT | 2011–2013 | 23 ICUs in France and Belgium | Solid or hematological cancer, AIDS, immunosuppressive drug or steroid | RR > 25/min, PaO2/FiO2 ≤ 300 mm Hg, PaCO2 ≤ 45 mm Hg |
Lemiale, 2017 | Post-hoc analysis of RCT | 2013–2015 | 28 ICUs in France and Belgium | Hematologic malignancy or solid tumor, solid organ transplant, long-term or high-dose steroid, immunosuppressive drug | PaO2 < 60 mm Hg on room air or tachypnea> 30/min or symptoms of respiratory distress |
Lemiale, 2015 | Open, parallel-group RCT | 2012–2014 | 4 ICUs in France | Solid or hematological cancer, solid organ transplant, long-term or high-dose steroid, immunosuppressive drug, HIV infection | O2 delivery >6 L/min to maintain SpO2 > 95% or symptoms of respiratory distress |
Mokart, 2015 | Retrospective | 2009–2014 | Single center in France | Cancer | Severe acute respiratory failure (O2 delivery >9 L/min) |
Roca, 2015 | Retrospective | 2007–2011 | Single center in Spain | Lung transplant | Inability to maintain SpO2 > 95% and an RR ≥ 25/min |
Azoulay, 2018 | RCT | 2016–2017 | 32 ICUs in France | Hematologic malignancy or solid tumor, solid organ transplant, long-term or high-dose steroid, immunosuppressive drug, primary immune deficiency | PaO2 < 60 mm Hg or SpO2 < 90% on room air or tachypnea >30/min or symptoms of respiratory distress, need for oxygen ≥6 L/min |
Study, Year | No. of Patients | Mean Age | Percentage of Common ARF Etiology | Severity | ||||
---|---|---|---|---|---|---|---|---|
HFNC | Control Group | HFNC | Control Group | HFNC | Control Group | HFNC | Control Group | |
Tu, 2017 | 20 | 18 (NIV) | 47 | 47 | NA | NA | SAPS II 37 (4) | SAPS II 35 (6) |
Coudroy, 2016 | 60 | 55 (NIV) | 58 | 62 | Infection (44%), cardiogenic edema (9%) | Infection (52%), cardiogenic edema (8%) | SAPS II 42 (11) SOFA 3 (1–6) | SAPS II 46 (13) SOFA 4 (1–6) |
Frat, 2016 | 26 | 30 (COT) | 62 | 63 | Pneumonia (66%), cancer (12%), others (23%) | Pneumonia (94%), cancer (3%), others (3%) | SAPS II 29 (11) | SAPS II 30 (17) |
Lemiale, 2017 | 90 | 90 (COT) | 64 | 63 | Infection (73.3%), cardiogenic edema (2.2%) other (24.4%) | Infection (68.8%), cardiogenic edema (2.2) other (28.8%) | SOFA 4 (2–6) | SOFA 3 (2–6) |
Lemiale, 2015 | 52 | 48 (COT) | 50 | 49 | Sepsis (48.1%), PJP (9.6%), cardiogenic edema (9.6%) | Sepsis (52%), PJP (4.1%), cardiogenic edema (4.1%) | SOFA 3.5 (2–6) SAPS II 42 (29.5–52) | SOFA 3 (2–5) SAPS II 37.5 (31–47) |
Mokart, 2015 | 69 (HFNC + NIV) | 59 (NIV + COT) | 56 | 59 | Pulmonary sepsis (65%), cancer (19%), others (26%) | Pulmonary sepsis (65%), cancer (9%), others (43%) | SOFA 6 (4–8) SPAS II 47 (37–55) | SOFA 6 (4–9) SAPS 48 (3859) |
Roca, 2015 | 22 | 18 (COT) | 56 | 53.5 | Infection (91.0%), rejection (4.5%) | Infection (72.2%), rejection (5.6%) | SOFA 4 (4–6) | SOFA 4 (4–6) |
Azoulay, 2018 | 388 | 388 (COT) | 64 | 63 | NA | NA | SAPS II 36 (28–46); SOFA 6 (4–8) | SAPS II 37 (28–48); SOFA 6 (4–8) |
Subgroup | No of Study | No of Patients | Random-Effect Model | I2 (%) | Test of Heterogeneity P | ||
---|---|---|---|---|---|---|---|
HFNC | Control | Risk Ratio | 95% CI | ||||
Comparator | |||||||
HFNC vs. COT | 5 | 578 | 574 | 0.86 | 0.75–0.95 | 0 | 0.57 |
HFNC vs. NIV | 2 | 80 | 73 | 0.59 | 0.40–0.86 | 0 | 0.39 |
HFNC + NIV vs. COT + NIV | 1 | 69 | 69 | 0.92 | 0.66–1.28 | NA | NA |
Study design | |||||||
RCT | 2 | 440 | 436 | 0.89 | 0.76–1.06 | 0 | 0.38 |
Retrospective study | 4 | 171 | 160 | 0.73 | 0.58–0.90 | 21 | 0.28 |
Post-hoc analysis | 2 | 116 | 120 | 0.81 | 0.61–1.07 | 0 | 0.68 |
Study site | |||||||
Single center | 4 | 171 | 160 | 0.73 | 0.58–0.90 | 21 | 0.28 |
Multicenter | 4 | 556 | 556 | 0.87 | 0.76–1.01 | 0 | 0.88 |
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Cheng, L.-C.; Chang, S.-P.; Wang, J.-J.; Hsiao, S.-Y.; Lai, C.-C.; Chao, C.-M. The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis. Medicina 2019, 55, 693. https://doi.org/10.3390/medicina55100693
Cheng L-C, Chang S-P, Wang J-J, Hsiao S-Y, Lai C-C, Chao C-M. The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis. Medicina. 2019; 55(10):693. https://doi.org/10.3390/medicina55100693
Chicago/Turabian StyleCheng, Li-Chin, Shen-Peng Chang, Jian-Jhong Wang, Sheng-Yen Hsiao, Chih-Cheng Lai, and Chien-Ming Chao. 2019. "The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis" Medicina 55, no. 10: 693. https://doi.org/10.3390/medicina55100693