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

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

doi:10.1186/s13054-022-04218-3

Critical Care

Table 1 Summary of Findings

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

Certainty assessment							No of patients		Effect		Certainty	Importance
No of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	HFNC	NIV	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Mortality
4	Randomized trials	Not serious^a	Not serious	Not serious	Very serious^b	None	18/127 (14.2%)	21/123 (17.1%)	RR 0.86 (0.48 to 1.56)	2 fewer per 100 (from 9 fewer to 10 more)	⨁⨁◯◯ Low
Intubation
4	Randomized trials	Not serious^a	Not serious	Not serious	Very serious^c	None	19/141 (13.5%)	23/134 (17.2%)	RR 0.80 (0.46 to 1.39)	3 fewer per 100 (from 9 fewer to 7 more)	⨁⨁◯◯ Low
ICU length of stay
2	Randomized trials	Not serious	Serious^d	Not serious	Serious^e	None	34	33	–	MD 0.08 higher (1.16 lower to 1.32 higher)	⨁⨁◯◯ Low
Hospital length of stay
4	Randomized trials	Not serious	Not serious	Not serious	Not serious^f	None	178	174	–	MD 0.82 lower (1.83 lower to 0.2 higher)	⨁⨁⨁⨁ High
Comfort
2	Randomized trials	serious^g	Serious^h	Not serious	Seriousⁱ	None	49	52	–	SMD 0.32 lower (1.78 lower to 1.13 higher)	⨁◯◯◯ Very low
Dyspnea
4	Randomized trials	serious^g	Not serious	Not serious	Serious^j	None	98	93	–	MD 0.04 lower (0.54 lower to 0.45 higher)	⨁⨁◯◯ Low
PaO₂
5	Randomized trials	Not serious^a	Not serious	Not serious	Not serious^k	None	215	212	–	MD 0.78 lower (4.18 lower to 2.62 higher)	⨁⨁⨁⨁ High
PaCO₂
7	Randomized trials	Not serious^a	Serious^l	Not serious	Not serious^k	None	245	242	–	MD 1.87 lower (5.34 lower to 1.6 higher)	⨁⨁⨁◯ Moderate
Respiratory rate
5	Randomized trials	Not serious^a	Not serious	Not serious	Serious^m	None	119	115	–	MD 0.85 lower (1.88 lower to 0.18 higher)	⨁⨁⨁◯ Moderate

CI Confidence interval; MD Mean difference; RR Risk ratio; SMD Standardized mean difference
a. All probably low risk except for greater than 10% dropout rate and more outcomes reported than described in methods in single study
b. Minimally important difference threshold of 3% is crossed (likely wide CI due to small sample size) and very few events
c. Minimally important difference threshold of 5% is crossed (likely wide CI due to small sample size) and very few events
d. Point estimates significantly different, I squared > 50%
e. Minimally important difference threshold of 2 days.is met. Imprecision due to small sample size
f. Minimally important difference threshold of 2 days is met
g. Subjective outcome which will be significantly affected by lack of blinding
h. Significant heterogeneity, I squared > 50%, different point estimates without overlapping confidence intervals, P < 0.1
i. Minimally important difference threshold of 1SD was crossed. Imprecision due to small number of participants
j. Minimally important difference threshold of 1SD. Imprecision due to small number of participants
k. For the minimally important difference (threshold 15 mmHg), we considered no difference in PCO₂ to be significant and there was a large number of total patients in the analysis
l. Significant difference in confidence intervals, borderline high I squared and P value < 0.1
m. Minimally important difference of 10 breaths per minute. Imprecision due to small number of participants

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ISSN: 1364-8535

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