Clinical efficacy of sequential HFNC versus NIPPV after extubation in AECOPD patients: a meta-analysis of randomized controlled trials_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIN Yingkang ¹ , LI Xiaoqian ¹ , CHEN Jing ² , LIN Xinfeng ² ,  CHEN Weitao ²

1. The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China;
2. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China;

Corresponding?author：

CHEN Weitao, Email: chenweitao1900@gzucm.edu.cn

Keywords：

Acute exacerbation of chronic obstructive pulmonary disease; sequential ventilation therapy; high-flow nasal cannula oxygen therapy; non-invasive positive pressure ventilation; Meta analysis

DOI：

10.7507/1671-6205.202304031

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods The Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. Result A total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. Conclusions Compared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.

Citation： LIN Yingkang, LI Xiaoqian, CHEN Jing, LIN Xinfeng, CHEN Weitao. Clinical efficacy of sequential HFNC versus NIPPV after extubation in AECOPD patients: a meta-analysis of randomized controlled trials. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(10): 727-735. doi: 10.7507/1671-6205.202304031 Copy

1.	賈文婷, 萬秋風, 徐思成, 等. 重癥社區獲得性肺炎高齡患者有創通氣序貫無創通氣的時機探討. 中華危重病急救醫學, 2020, 32(3): 324-329.
2.	Lee JH, Rehder KJ, Williford L, et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med, 2013, 39(2): 247-257.
3.	中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 2019, 42(2): 83-91.
4.	侯曉雯, 時景璞, 陳欣. 在Meta分析中如何利用中位數、極差和樣本量估算均數、標準差. 中國循證醫學雜志, 2015, 15(4): 484-487.
5.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10): 1115-1118.
6.	胡佚凡, 高錦, 李娜, 等. 有創ETI-MV后HFNC與NIPPV治療老年COPD合并呼吸衰竭的臨床效果分析. 重慶醫學, 2022, 51(11): 1908-1911.
7.	楊小雪, 卓越, 丁偉超, 等. 慢性阻塞性肺疾病急性加重機械通氣患者序貫HFNC與NPPV的療效比較. 國際麻醉學與復蘇雜志, 2022, 43(1): 29-33.
8.	曹鵬, 凌冰玉, 徐艷, 等. 有創–高流量氧療與有創–無創通氣序貫治療慢性阻塞性肺疾病并嚴重呼吸衰竭的隨機對照研究. 中國呼吸與危重監護雜志, 2021, 20(6): 388-395.
9.	方國強, 萬秋風, 田雅潔, 等. AECOPD致嚴重呼吸衰竭患者早期拔管后序貫經鼻高流量濕化氧療與無創正壓通氣的優劣比較. 中華危重病急救醫學, 2021, 33(10): 1215-1220.
10.	孫章萍, 程志華, 閆福棟. 經鼻高流量濕化氧療對慢性阻塞性肺疾病并發呼吸功能衰竭患者的價值. 黑龍江醫藥, 2021, 34(4): 904-907.
11.	吳松, 黃世霜, 王香. 序貫經鼻高流量氧療對COPD機械通氣患者血氣指標及肺功能的影響. 數理醫藥學雜志, 2021, 34(10): 1435-1437.
12.	席卓娜. 有創機械通氣—高流量氧療序貫治療慢性阻塞性肺疾病合并呼吸衰竭的臨床效果. 臨床研究, 2021, 29(8): 104-106.
13.	黃靜銘, 梁志金, 黃連意. 經鼻高流量氧療與無創正壓通氣在AECOPD病人拔管后序貫治療的效果觀察. 循證護理, 2020, 6(6): 565-569.
14.	蔣光輝, 毛媛, 唐婭群, 等. 高流量氧療與無創通氣在AECOPD序貫治療中比較研究. 江西醫藥, 2020, 55(8): 975-978.
15.	陳棟玉, 何磊, 周亮亮, 等. 有創機械通氣–高流量氧療序貫治療慢性阻塞性肺疾病所致急性呼吸衰竭的臨床研究. 中華重癥醫學電子雜志, 2019, 5(3): 219-224.
16.	林懷印, 付會文, 趙智東, 等. 慢性阻塞性肺疾病患者拔管后序貫經鼻高流量氧療的效果研究. 檢驗醫學與臨床, 2019, 16(12): 1646-1649.
17.	劉景剛, 楊圣強, 袁繼印, 等. 經鼻高流量氧療序貫治療慢性阻塞性肺疾病機械通氣患者的臨床研究. 中華急診醫學雜志, 2019, 28(4): 459-462.
18.	於江泉, 鄭瑞強, 朱進, 等. 經鼻高流量氧療在慢性阻塞性肺疾病急性加重患者有創呼吸機序貫治療中的臨床效果. 中華重癥醫學電子雜志, 2019, 5(3): 213-218.
19.	喻正浩, 張瑞, 黃卉, 等. 經鼻高流量濕化氧療應用于慢性阻塞性肺疾病合并2型呼吸衰竭患者氣管插管拔管后的療效和安全性: 隨機對照研究. 第二軍醫大學學報, 2019, 40(9): 989-994.
20.	徐曉翠, 王金柱, 姚惠萍. 經鼻高流量濕化氧療對COPD患者拔管后再插管及呼吸衰竭的影響. 齊魯護理雜志, 2018, 24(5): 1-3.
21.	張京臣, 吳逢選, 孟琳琳, 等. 慢性阻塞性肺疾病患者拔管后序貫經鼻高流量氧療的效果及安全性. 中華醫學雜志, 2018, 98(2): 109-112.
22.	韓曉霖, 劉述平, 劉一誠, 等. 經鼻高流量氧療對AECOPD患者撤機效果的影響. 湖南師范大學學報(醫學版), 2018, 15(1): 145-148.
23.	Xu S, Liu X. Sequential treatment of chronic obstructive pulmonary disease concurrent with respiratory failure by high-flow nasal cannula therapy. Am J Transl Res, 2021, 13(4): 2831-2839.
24.	Tan DY, Walline JH, Ling BY, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Critical Care, 2020, 24(1): 489.
25.	Jing GQ, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health, 2019, 42(3): 217-225.
26.	江學成. 危重疾病嚴重程度評分臨床應用和意義. 中國危重病急救醫學, 2000, 12(4): 195-197.
27.	慢性阻塞性肺疾病急性加重診治專家組. 慢性阻塞性肺疾病急性加重診治中國專家共識(2023年修訂版). 國際呼吸雜志, 2023, 43(2): 132-149.
28.	Feng ZZ, Zhang L, Yu HC, et al. 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. Int J Chron Obstruct Pulmon Dis, 2022, 17: 1987-1999.
29.	簡佳慶, 段鳳英, 肖遠超, 等. ICU拔除氣管插管患者使用經鼻高流量濕化氧療對比傳統氧療或無創正壓通氣臨床療效的Meta分析. 中國呼吸與危重監護雜志, 2019, 18(1): 42-50.
30.	王辰, 商鳴宇, 黃克武, 等. 有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的研究. 中華結核和呼吸雜志, 2000, 23(4): 212-216.

1. 賈文婷, 萬秋風, 徐思成, 等. 重癥社區獲得性肺炎高齡患者有創通氣序貫無創通氣的時機探討. 中華危重病急救醫學, 2020, 32(3): 324-329.
2. Lee JH, Rehder KJ, Williford L, et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med, 2013, 39(2): 247-257.
3. 中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 2019, 42(2): 83-91.
4. 侯曉雯, 時景璞, 陳欣. 在Meta分析中如何利用中位數、極差和樣本量估算均數、標準差. 中國循證醫學雜志, 2015, 15(4): 484-487.
5. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10): 1115-1118.
6. 胡佚凡, 高錦, 李娜, 等. 有創ETI-MV后HFNC與NIPPV治療老年COPD合并呼吸衰竭的臨床效果分析. 重慶醫學, 2022, 51(11): 1908-1911.
7. 楊小雪, 卓越, 丁偉超, 等. 慢性阻塞性肺疾病急性加重機械通氣患者序貫HFNC與NPPV的療效比較. 國際麻醉學與復蘇雜志, 2022, 43(1): 29-33.
8. 曹鵬, 凌冰玉, 徐艷, 等. 有創–高流量氧療與有創–無創通氣序貫治療慢性阻塞性肺疾病并嚴重呼吸衰竭的隨機對照研究. 中國呼吸與危重監護雜志, 2021, 20(6): 388-395.
9. 方國強, 萬秋風, 田雅潔, 等. AECOPD致嚴重呼吸衰竭患者早期拔管后序貫經鼻高流量濕化氧療與無創正壓通氣的優劣比較. 中華危重病急救醫學, 2021, 33(10): 1215-1220.
10. 孫章萍, 程志華, 閆福棟. 經鼻高流量濕化氧療對慢性阻塞性肺疾病并發呼吸功能衰竭患者的價值. 黑龍江醫藥, 2021, 34(4): 904-907.
11. 吳松, 黃世霜, 王香. 序貫經鼻高流量氧療對COPD機械通氣患者血氣指標及肺功能的影響. 數理醫藥學雜志, 2021, 34(10): 1435-1437.
12. 席卓娜. 有創機械通氣—高流量氧療序貫治療慢性阻塞性肺疾病合并呼吸衰竭的臨床效果. 臨床研究, 2021, 29(8): 104-106.
13. 黃靜銘, 梁志金, 黃連意. 經鼻高流量氧療與無創正壓通氣在AECOPD病人拔管后序貫治療的效果觀察. 循證護理, 2020, 6(6): 565-569.
14. 蔣光輝, 毛媛, 唐婭群, 等. 高流量氧療與無創通氣在AECOPD序貫治療中比較研究. 江西醫藥, 2020, 55(8): 975-978.
15. 陳棟玉, 何磊, 周亮亮, 等. 有創機械通氣–高流量氧療序貫治療慢性阻塞性肺疾病所致急性呼吸衰竭的臨床研究. 中華重癥醫學電子雜志, 2019, 5(3): 219-224.
16. 林懷印, 付會文, 趙智東, 等. 慢性阻塞性肺疾病患者拔管后序貫經鼻高流量氧療的效果研究. 檢驗醫學與臨床, 2019, 16(12): 1646-1649.
17. 劉景剛, 楊圣強, 袁繼印, 等. 經鼻高流量氧療序貫治療慢性阻塞性肺疾病機械通氣患者的臨床研究. 中華急診醫學雜志, 2019, 28(4): 459-462.
18. 於江泉, 鄭瑞強, 朱進, 等. 經鼻高流量氧療在慢性阻塞性肺疾病急性加重患者有創呼吸機序貫治療中的臨床效果. 中華重癥醫學電子雜志, 2019, 5(3): 213-218.
19. 喻正浩, 張瑞, 黃卉, 等. 經鼻高流量濕化氧療應用于慢性阻塞性肺疾病合并2型呼吸衰竭患者氣管插管拔管后的療效和安全性: 隨機對照研究. 第二軍醫大學學報, 2019, 40(9): 989-994.
20. 徐曉翠, 王金柱, 姚惠萍. 經鼻高流量濕化氧療對COPD患者拔管后再插管及呼吸衰竭的影響. 齊魯護理雜志, 2018, 24(5): 1-3.
21. 張京臣, 吳逢選, 孟琳琳, 等. 慢性阻塞性肺疾病患者拔管后序貫經鼻高流量氧療的效果及安全性. 中華醫學雜志, 2018, 98(2): 109-112.
22. 韓曉霖, 劉述平, 劉一誠, 等. 經鼻高流量氧療對AECOPD患者撤機效果的影響. 湖南師范大學學報(醫學版), 2018, 15(1): 145-148.
23. Xu S, Liu X. Sequential treatment of chronic obstructive pulmonary disease concurrent with respiratory failure by high-flow nasal cannula therapy. Am J Transl Res, 2021, 13(4): 2831-2839.
24. Tan DY, Walline JH, Ling BY, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Critical Care, 2020, 24(1): 489.
25. Jing GQ, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health, 2019, 42(3): 217-225.
26. 江學成. 危重疾病嚴重程度評分臨床應用和意義. 中國危重病急救醫學, 2000, 12(4): 195-197.
27. 慢性阻塞性肺疾病急性加重診治專家組. 慢性阻塞性肺疾病急性加重診治中國專家共識(2023年修訂版). 國際呼吸雜志, 2023, 43(2): 132-149.
28. Feng ZZ, Zhang L, Yu HC, et al. 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. Int J Chron Obstruct Pulmon Dis, 2022, 17: 1987-1999.
29. 簡佳慶, 段鳳英, 肖遠超, 等. ICU拔除氣管插管患者使用經鼻高流量濕化氧療對比傳統氧療或無創正壓通氣臨床療效的Meta分析. 中國呼吸與危重監護雜志, 2019, 18(1): 42-50.
30. 王辰, 商鳴宇, 黃克武, 等. 有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的研究. 中華結核和呼吸雜志, 2000, 23(4): 212-216.

Previous Article
A study on the characteristics of smoking quitting population and smoking control strategies in Hong Kong from 2010 to 2021
Next Article
遺傳性抗凝血酶缺乏癥一例并文獻復習

Chinese Journal of Respiratory and Critical Care Medicine

Clinical efficacy of sequential HFNC versus NIPPV after extubation in AECOPD patients: a meta-analysis of randomized controlled trials

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content