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; [Les canules nasales à haut débit pour le traitement de l’insuffisance respiratoire hypoxémique aiguë chez les patients atteints de la COVID-19: comptes rendus systématiques de l’efficacité et des risques d’aérosolisation, de dispersion et de transmission de l’infection]

被引：0

作者：

Agarwal A. ^{[1
,27
]}

Basmaji J. ^{[2
]}

Muttalib F. ^{[3
]}

Granton D. ^{[4
]}

Chaudhuri D. ^{[5
]}

Chetan D. ^{[6
,7
,27
]}

Hu M. ^{[4
]}

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

Honarmand K. ^{[2
,10
]}

Bakaa L. ^{[11
]}

Brar S. ^{[12
]}

Rochwerg B. ^{[4
,5
,13
]}

Adhikari N.K. ^{[14
,15
,27
]}

Lamontagne F. ^{[16
,17
]}

Murthy S. ^{[18
]}

Hui D.S.C. ^{[19
,20
]}

Gomersall C. ^{[21
]}

Mubareka S. ^{[22
,23
,27
]}

Diaz J.V. ^{[24
,25
]}

Burns K.E.A. ^{[26
,27
,28
]}

Couban R. ^{[13
,29
]}

Ibrahim Q. ^{[13
]}

Guyatt G.H. ^{[13
]}

Vandvik P.O. ^{[30
]}

机构：

[1] Department of Medicine, University of Toronto, Toronto, ON

[2] Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON

[3] Centre for Global Child Health, Hospital for Sick Children, Toronto, ON

[4] Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON

[5] Department of Medicine, McMaster University, Hamilton, ON

[6] Department of Pediatrics, University of Toronto, Toronto, ON

[7] Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON

[8] Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON

[9] Department of Emergency Medicine, University of Ottawa, Ottawa, ON

[10] Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, ON

[11] Honours Life Sciences Program, Faculty of Science, McMaster University, Hamilton, ON

[12] School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY

[13] Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON

[14] Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON

[15] Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON

[16] Université de Sherbrooke, Sherbrooke

[17] Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC

[18] BC Children’s Hospital, University of British Columbia, Vancouver, BC

[19] Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin

[20] Stanley Ho, Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin

[21] Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong

[22] Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON

[23] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON

[24] Pacific Medical Center, San Francisco, CA

[25] World Health Organization, Geneva

[26] Unity Health Toronto – St. Michael’s Hospital, Toronto, ON

[27] University of Toronto, Toronto, ON

[28] Li Ka Shing Knowledge Institute, Toronto, ON

[29] Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON

[30] MAGIC Evidence Ecosystem Foundation, Oslo

来源：

Canadian Journal of Anesthesia/Journal canadien d'anesthésie | 2020年 / 67卷 / 9期

关键词：

aerosols; COVID-19; high-flow nasal cannula; respiratory failure; SARS-CoV-2;

D O I：

10.1007/s12630-020-01740-2

中图分类号：

学科分类号：

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. © 2020, Canadian Anesthesiologists' Society.

引用

页码：1217 / 1248

页数：31

共 66 条

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