Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study

Cheng-Chieh Huang; Hao-Min Lan; Chao-Jui Li; Tsung-Han Lee; Wen-Liang Chen; Wei-Yuan Lei; Pei-You Hsieh; Mei-Chueh Yang; Chu-Chung Chou; Han-Ping Wu; Yuan-Jhen Syue

doi:10.1155/2019/2130935

Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study

Emerg Med Int. 2019 Oct 13:2019:2130935. doi: 10.1155/2019/2130935. eCollection 2019.

Authors

Cheng-Chieh Huang^{1

2}, Hao-Min Lan³, Chao-Jui Li^{4

5}, Tsung-Han Lee^{1

2}, Wen-Liang Chen², Wei-Yuan Lei¹, Pei-You Hsieh¹, Mei-Chueh Yang¹, Chu-Chung Chou^{1

6

7}, Han-Ping Wu^{8

9

10}, Yuan-Jhen Syue¹¹

Affiliations

¹ Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
² Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
³ Department of Education, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁴ Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁵ Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan.
⁶ School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Department of Pediatric Emergency Medicine, Children Hospital, China Medical University, Taichung, Taiwan.
⁹ Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan.
¹⁰ Department of Medical Research, Children's Hospital, China Medical University, Taichung, Taiwan.
¹¹ Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Abstract

Objective: To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy (COT) or noninvasive ventilation (NIV) for the treatment of acute respiratory failure (ARF) in emergency departments (EDs).

Method: We comprehensively searched 3 databases (PubMed, EMBASE, and the Cochrane Library) for articles published from database inception to 12 July 2019. This study included only randomized controlled trials (RCTs) that were conducted in EDs and compared HFNC therapy with COT or NIV. The primary outcome was the intubation rate. The secondary outcomes were the mortality rate, intensive care unit (ICU) admission rate, ED discharge rate, need for escalation, length of ED stay, length of hospital stay, and patient dyspnea and comfort scores.

Result: Five RCTs (n = 775) were included. There was a decreasing trend regarding the application of HFNC therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% CI, 0.26-1.09; p=0.08; I ² = 0%). We found that compared with patients who underwent COT, those who underwent HFNC therapy had a reduced need for escalation (RR, 0.41; 95% CI, 0.22-0.78; p=0.006; I ² = 0%), reduced dyspnea scores (MD -0.82, 95% CI -1.45 to -0.18), and improved comfort (SMD -0.76 SD, 95% CI -1.01 to -0.51). Compared with the COT group, the HFNC therapy group had a similar mortality rate (RR, 1.25; 95% CI, 0.79-1.99; p=0.34; I ² = 0%), ICU admission rate (RR, 1.11; 95% CI, 0.58-2.12; p=0.76; I ² = 0%), ED discharge rate (RR, 1.04; 95% CI, 0.63-1.72; p=0.87; I ² = 0%), length of ED stay (MD 1.66, 95% CI -0.95 to 4.27), and hospital stay (MD 0.9, 95% CI -2.06 to 3.87).

Conclusion: Administering HFNC therapy in ARF patients in EDs might decrease the intubation rate compared with COT. In addition, it can decrease the need for escalation, decrease the patient's dyspnea level, and increase the patient's comfort level compared with COT.