Evidence map›Paper›PMID 36352457›Full record

SynthesisCritical care (London, England)2022

High-flow nasal cannula versus non-invasive ventilation for acute hypercapnic respiratory failure in adults: a systematic review and meta-analysis of randomized trials.

N Ovtcharenko, E Ho, W Alhazzani, A Cortegiani, B Ergan, R Scala, G Sotgiu, D Chaudhuri, S Oczkowski, K Lewis

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 7 pooled it
6.5field-weighted citation impact, top 2% 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

34 citing papers in PubMed, 7 syntheses or guidelines pooled it, 48 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2023
    Pooled it
  7. Pooled it
  8. Trial
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Observational
  15. Article
  16. Article
  17. Review
  18. Article
  19. Article
  20. Review
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

10 authors at 6 institutions in 3 countries.

N OvtcharenkoDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
E HoFaculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
W AlhazzaniDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
A CortegianiDepartment of Surgical Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy.
B ErganDepartment of Pulmonary and Critical Care, Dokuz Eylul University School of Medicine, Izmir, Turkey.
R ScalaPulmonology and Respiratory Intensive Care Unit, Cardio-Thoraco-Neuro-Vascular Department, USL Toscana Sudest, S Donato Hospital, Arezzo, Italy.
G SotgiuClinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
D ChaudhuriDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
S OczkowskiDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
K LewisDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. lewiska@mcmaster.ca.
McMaster University · CAImpact · CADokuz Eylül University · TROspedale San Donato · ITUniversity of Palermo · ITUniversity of Sassari · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNon-invasive ventilation (NIV) with bi-level positive pressure ventilation is a first-line intervention for selected patients with acute hypercapnic respiratory failure. Compared to conventional oxygen therapy, NIV may reduce endotracheal intubation, death, and intensive care unit length of stay (LOS), but its use is often limited by patient tolerance and treatment failure. High-flow nasal cannula (HFNC) is a potential alternative treatment in this patient population and may be better tolerated. RESEARCH QUESTION: For patients presenting with acute hypercapnic respiratory failure, is HFNC an effective alternative to NIV in reducing the need for intubation?

methodsWe searched EMBASE, MEDLINE, and the Cochrane library from database inception through to October 2021 for randomized clinical trials (RCT) of adults with acute hypercapnic respiratory failure assigned to receive HFNC or NIV. The Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. We calculated pooled relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with corresponding 95% confidence intervals (CI) using a random-effects model.

resultsWe included eight RCTs (n = 528) in the final analysis. The use of HFNC compared to NIV did not reduce the risk of our primary outcome of mortality (RR 0.86, 95% CI 0.48-1.56, low certainty), or our secondary outcomes including endotracheal intubation (RR 0.80, 95% CI 0.46-1.39, low certainty), or hospital LOS (MD - 0.82 days, 95% CI - 1.83-0.20, high certainty). There was no difference in change in partial pressure of carbon dioxide between groups (MD - 1.87 mmHg, 95% CI - 5.34-1.60, moderate certainty).

interpretationThe current body of evidence is limited in determining whether HFNC may be either superior, inferior, or equivalent to NIV for patients with acute hypercapnic respiratory failure given imprecision and study heterogeneity. Further studies are needed to better understand the effect of HFNC on this population.

Indexed as

Noninvasive VentilationRespiratory InsufficiencyAdultCannulaHumansOxygen Inhalation TherapyRandomized Controlled Trials as TopicHigh-flow nasal cannulaHypercapnic respiratory failureNon-invasive ventilation

Identifiers

PMID36352457
PMCPMC9648030
OpenAlexW4308730515

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.