High-Flow Nasal Oxygen versus Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Meta-Analysis of Randomized Controlled Trials

• Published in: Canadian respiratory journal 2023-06, Vol.2023, p.7707010-12
• Main Authors: Du, Yanping, Zhang, Huaping, Ma, Zhiyi, Liu, Jun, Wang, Zhiyong, Lin, Meixia, Ni, Fayu, Li, Xi, Tan, Hui, Tan, Shifan, Chai, Yanling, Zhong, Xiangzhu
• Format: Article
• Language: English
• Subjects: Carbon dioxide; Care and treatment; China; Chronic obstructive pulmonary disease; Clinical outcomes; Clinical trials; Comparative analysis; Complications and side effects; Confidence intervals; Diseases; Extubation; Handbooks; Health aspects; Heart rate; Humans; Intubation; Lung diseases, Obstructive; Medical research; Medicine, Experimental; Meta-analysis; Methods; Mortality; Noninvasive Ventilation; Online databases; Oxygen; Oxygen equipment (Medical care); Oxygen Inhalation Therapy; Oxygen saturation; Oxygen therapy; Patient compliance; Physiological aspects; Pulmonary Disease, Chronic Obstructive - drug therapy; Randomized Controlled Trials as Topic; Respiratory Insufficiency - therapy; Statistical analysis; Testing; Ventilators; Vital signs
• ISSN: 1198-2241; 1916-7245
• DOI: 10.1155/2023/7707010

Background. High-flow nasal cannula (HFNC) can be used in stable chronic obstructive pulmonary disease (COPD) patients, but the effect of HFNC on clinical outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still uncertain. Methods. We searched electronic literature databases for randomized controlled trials (RCTs) comparing HFNC with noninvasive ventilation (NIV) in hypercapnic patients with AECOPD. The primary endpoint of this meta-analysis was PaCO2, PaO2, and SpO2. The secondary outcomes were the respiratory rate, mortality, complications, and intubation rate. Results. We included 7 RCTs with a total of 481 patients. There were no significant differences on measures of PaCO2 (MD = −0.42, 95%CI −3.60 to 2.75, Z = 0.26, and P = 0.79), PaO2 (MD = −1.36, 95%CI −4.69 to 1.97, Z = 0.80, and P = 0.42), and SpO2 (MD = −0.78, 95%CI −1.67 to 0.11, Z = 1.72, P = 0.08) between the HFNC group and the NIV group. There was no significant difference in measures of the mortality and intubation rate between the HFNC group (OR = 0.72, 95%CI 0.30 to 1.69, Z = 0.76, and P = 0.44) and the NIV group (OR = 2.38, 95%CI 0.49 to 11.50, Z = 1.08, and P = 0.28), respectively. But the respiratory rate in the HFNC group was lower than that in the NIV group (MD = −1.13, 95%CI −2.13 to −0.14, Z = 2.23, and P = 0.03), and fewer complications were found in the HFNC group (OR = 0.26, 95%CI 0.14 to 0.47, Z = 4.46, and P