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JA Clinical Reports

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Open Access 01-12-2022 | Original article

Respiratory support strategy in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

Authors: Hiromu Okano, Masaaki Sakuraya, Tomoyuki Masuyama, Shunsuke Kimata, Satoshi Hokari

Published in: JA Clinical Reports | Issue 1/2022

Abstract

Introduction

Network meta-analyses (NMAs) of respiratory management strategies for acute hypoxemic respiratory failure (AHRF) have been reported, but no previous study has compared noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), standard oxygenation therapy (SOT), and invasive mechanical ventilation (IMV) for de novo AHRF. Therefore, we conducted an NMA to assess the effectiveness of these four respiratory strategies in patients with de novo AHRF.

Methods

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥18 years with AHRF and RCTs that compared two different oxygenation techniques (SOT, NIV, HFNO, or IMV) were selected. A frequentist-based approach with multivariate random-effects meta-analysis was used. The outcomes were mortality and intubation rates.

Results

Among the 14,263 records initially identified, 25 studies (3302 patients) were included. In the analysis of mortality, compared to SOT, NIV (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.61–0.95) reduced mortality; however, IMV (RR, 1.01; 95% CI, 0.57–1.78) and HFNO (RR, 0.89; 95% CI, 0.66–1.20) did not. For assessments of the intubation incidence, compared to SOT, NIV use (RR, 0.63; 95% CI, 0.51–0.79) was associated with a reduction in intubation, but HFNO (RR, 0.82; 95% CI, 0.61–1.11) was not significant.

Conclusions

Our NMA demonstrated that only NIV showed clinical benefits compared with SOT as an initial respiratory strategy for de novo AHRF. Further investigation, especially comparison with HFNO, is warranted.

Trial registration

PROSPERO (registration number: CRD42020213948, 11/11/2020).

Available only for authorised users

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Title: Respiratory support strategy in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis
Authors: Hiromu Okano
Masaaki Sakuraya
Tomoyuki Masuyama
Shunsuke Kimata
Satoshi Hokari
Publication date: 01-12-2022
Publisher: Springer Berlin Heidelberg
Published in: JA Clinical Reports / Issue 1/2022
Electronic ISSN: 2363-9024
DOI: https://doi.org/10.1186/s40981-022-00525-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Respiratory support strategy in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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