Evidence map›Paper›PMID 32542464›Full record

SynthesisCanadian journal of anaesthesia = Journal canadien d'anesthesie2020

High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission.

Arnav Agarwal, John Basmaji, Fiona Muttalib, David Granton, Dipayan Chaudhuri, Devin Chetan, Malini Hu, Shannon M Fernando, Kimia Honarmand, Layla Bakaa and 14 more

Open access · bronzeAbstract readComparative StudySystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 95 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
95citing papers in PubMed, 3 pooled it
23.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

95 citing papers in PubMed, 3 syntheses or guidelines pooled it, 212 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
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  7. Review
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  11. Observational
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  13. Article
  14. Respiratory Care in Children with COVID-19.Journal of pediatric intensive care · 2023
    Review
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  16. Review
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  20. Article

35 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors at 14 institutions in 5 countries.

Arnav AgarwalDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
John BasmajiDivision of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Fiona MuttalibCentre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
David GrantonMichael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Dipayan ChaudhuriDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Devin ChetanDepartment of Pediatrics, University of Toronto, Toronto, ON, Canada.
Malini HuMichael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Kimia HonarmandDivision of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Layla BakaaHonours Life Sciences Program, Faculty of Science, McMaster University, Hamilton, ON, Canada.
Sonia BrarSchool of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA.
Bram RochwergMichael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Neill K AdhikariDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Francois LamontagneUniversité de Sherbrooke, Sherbrooke, Canada.
Srinivas MurthyBC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
David S C HuiDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
Charles GomersallDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
Samira MubarekaDivision of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Janet V DiazPacific Medical Center, San Francisco, CA, USA.
Karen E A BurnsUnity Health Toronto - St. Michael's Hospital, Toronto, ON, Canada.
Rachel CoubanDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Quazi IbrahimDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Gordon H GuyattDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Per O VandvikMAGIC Evidence Ecosystem Foundation, Oslo, Norway. per.vandvik@gmail.com.ORCID http://orcid.org/0000-0001-8958-2710
Impact · CAMcMaster University · CAChinese University of Hong Kong · HKSunnybrook Health Science Centre · CAUniversity of Toronto · CAWestern University · CACalifornia Pacific Medical Center · USHospital for Sick Children · CANorwegian Agency for Development Cooperation · NOSt. Michael's Hospital · CAUniversité de Sherbrooke · CAUniversity at Buffalo, State University of New York · USUniversity of British Columbia · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWe conducted two World Health Organization-commissioned reviews to inform use of high-flow nasal cannula (HFNC) in patients with coronavirus disease (COVID-19). We synthesized the evidence regarding efficacy and safety (review 1), as well as risks of droplet dispersion, aerosol generation, and associated transmission (review 2) of viral products. SOURCE: Literature searches were performed in Ovid MEDLINE, Embase, Web of Science, Chinese databases, and medRxiv. Review 1: we synthesized results from randomized-controlled trials (RCTs) comparing HFNC to conventional oxygen therapy (COT) in critically ill patients with acute hypoxemic respiratory failure. Review 2: we narratively summarized findings from studies evaluating droplet dispersion, aerosol generation, or infection transmission associated with HFNC. For both reviews, paired reviewers independently conducted screening, data extraction, and risk of bias assessment. We evaluated certainty of evidence using GRADE methodology. PRINCIPAL

findingsNo eligible studies included COVID-19 patients. Review 1: 12 RCTs (n = 1,989 patients) provided low-certainty evidence that HFNC may reduce invasive ventilation (relative risk [RR], 0.85; 95% confidence interval [CI], 0.74 to 0.99) and escalation of oxygen therapy (RR, 0.71; 95% CI, 0.51 to 0.98) in patients with respiratory failure. Results provided no support for differences in mortality (moderate certainty), or in-hospital or intensive care length of stay (moderate and low certainty, respectively). Review 2: four studies evaluating droplet dispersion and three evaluating aerosol generation and dispersion provided very low certainty evidence. Two simulation studies and a crossover study showed mixed findings regarding the effect of HFNC on droplet dispersion. Although two simulation studies reported no associated increase in aerosol dispersion, one reported that higher flow rates were associated with increased regions of aerosol density.

conclusionsHigh-flow nasal cannula may reduce the need for invasive ventilation and escalation of therapy compared with COT in COVID-19 patients with acute hypoxemic respiratory failure. This benefit must be balanced against the unknown risk of airborne transmission.

Indexed as

AerosolsCannulaCoronavirus InfectionsCOVID-19HumansOxygen Inhalation TherapyPandemicsPneumonia, ViralRandomized Controlled Trials as TopicRespiratory InsufficiencyAerosolsaerosolsCOVID-19high-flow nasal cannularespiratory failureSARS-CoV-2

Identifiers

PMID32542464
PMCPMC7294988
OpenAlexW3035761977

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.