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

被引：2

作者：

Agarwal, Arnav ^{[1
]}

Basmaji, John ^{[2
]}

Muttalib, Fiona ^{[3
]}

Granton, David ^{[4
]}

Chaudhuri, Dipayan ^{[5
]}

Chetan, Devin ^{[6
,7
]}

Hu, Malini ^{[4
]}

Fernando, Shannon M. ^{[8
,9
]}

Honarmand, Kimia ^{[2
,10
]}

Bakaa, Layla ^{[11
]}

Brar, Sonia ^{[12
]}

Rochwerg, Bram ^{[5
,13
,14
]}

Adhikari, Neill K. ^{[15
,16
]}

Lamontagne, Francois ^{[17
,18
]}

Murthy, Srinivas ^{[19
]}

Hui, David S. C. ^{[20
,21
]}

Gomersall, Charles ^{[22
]}

Mubareka, Samira ^{[23
,24
]}

Diaz, Janet V. ^{[25
,26
]}

Burns, Karen E. A. ^{[27
,28
,29
]}

Couban, Rachel ^{[14
,30
]}

Ibrahim, Quazi ^{[14
]}

Guyatt, Gordon H. ^{[14
]}

Vandvik, Per O. ^{[31
]}

机构：

[1] Univ Toronto, Dept Med, Toronto, ON, Canada

[2] Western Univ, Schulich Sch Med & Dent, Dept Med, Div Crit Care, London, ON, Canada

[3] Hosp Sick Children, Ctr Global Child Hlth, Toronto, ON, Canada

[4] McMaster Univ, Michael G DeGroote Sch Med, Hamilton, ON, Canada

[5] McMaster Univ, Dept Med, Hamilton, ON, Canada

[6] Univ Toronto, Dept Pediat, Toronto, ON, Canada

[7] Hosp Sick Children, Labatt Family Heart Ctr, Div Cardiol, Toronto, ON, Canada

[8] Univ Ottawa, Dept Med, Div Crit Care, Ottawa, ON, Canada

[9] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada

[10] Western Univ, Dept Med, Schulich Sch Med & Dent, London, ON, Canada

[11] McMaster Univ, Fac Sci, Honours Life Sci Program, Hamilton, ON, Canada

[12] SUNY Buffalo, Sch Med & Biomed Sci, Buffalo, NY USA

[13] McMaster Univ, Michael G DeGroote Sch Med, Hamilton, ON, Canada

[14] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[15] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada

[16] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[17] Univ Sherbrooke, Sherbrooke, PQ, Canada

[18] CHU Sherbrooke, Ctr Rech, Sherbrooke, PQ, Canada

[19] Univ British Columbia, BC Childrens Hosp, Vancouver, BC, Canada

[20] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Peoples R China

[21] Chinese Univ Hong Kong, Ctr Emerging Infect Dis, Hong Kong, Peoples R China

[22] Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Hong Kong, Peoples R China

[23] Sunnybrook Hlth Sci Ctr, Div Infect Dis, Toronto, ON, Canada

[24] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada

[25] Pacific Med Ctr, San Francisco, CA USA

[26] WHO, Geneva, Switzerland

[27] St Michaels Hosp, Unity Hlth Toronto, Toronto, ON, Canada

[28] Univ Toronto, Toronto, ON, Canada

[29] Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[30] McMaster Univ, Michael G DeGroote Inst Pain Res & Care, Hamilton, ON, Canada

[31] MAGIC Evidence Ecosyst Fdn, Oslo, Norway

来源：

CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 2020年 / 67卷 / 09期

关键词：

respiratory failure; COVID-19; SARS-CoV-2; high-flow nasal cannula; aerosols; CONVENTIONAL OXYGEN-THERAPY; POSITIVE-PRESSURE VENTILATION; RANDOMIZED CONTROLLED-TRIAL; NONINVASIVE VENTILATION; ENDOTRACHEAL INTUBATION; MECHANICAL VENTILATION; EMERGENCY-DEPARTMENT; AIRWAY PRESSURE; ADULT PATIENTS; INFLUENZA;

D O I：

10.1007/s12630-020-01740-2

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Purpose We 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 findings No 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. Conclusions High-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.

引用

页码：1217 / 1248

页数：32

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