Zhaoshuang Zhong, Long Zhao, Yan Zhao, Rongmei Li, Shuyue Xia
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No significant differences were observed in mortality (I<sup>2</sup> = 0.0%, P = 0.818; RR 1.000, 95% CI 0.638 to 1.569, P = 0.999) or intubation rates (I<sup>2</sup> = 22.1%, P = 0.253; RR 1.401, 95% CI 0.790 to 2.484, P = 0.249). Although HFNC significantly reduced treatment intolerance (I<sup>2</sup> = 0.0%, P = 0.976; RR 0.145, 95% CI 0.048 to 0.438, P = 0.001), it showed a non-significant trend toward a higher treatment failure rate compared to NIV (I<sup>2</sup> = 36.2%, P = 0.180; RR 1.553, 95% CI 0.955 to 2.524, P = 0.076).</p><p><strong>Conclusion: </strong>HFNC therapy showed a trend towards a higher treatment failure rate compared to NIV, though the difference was not statistically significant. 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However, direct comparative evidence on the clinical efficacy of HFNC versus NIV in acute exacerbations of COPD (AECOPD) remains limited and inconclusive.</p><p><strong>Methods: </strong>A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted up to January 2025 for randomized controlled trials (RCTs) comparing HFNC and NIV in AECOPD patients. Outcomes included mortality, treatment failure, intubation rates, and treatment intolerance.</p><p><strong>Results: </strong>Nine RCTs involving 786 patients were included in the meta-analysis. No significant differences were observed in mortality (I<sup>2</sup> = 0.0%, P = 0.818; RR 1.000, 95% CI 0.638 to 1.569, P = 0.999) or intubation rates (I<sup>2</sup> = 22.1%, P = 0.253; RR 1.401, 95% CI 0.790 to 2.484, P = 0.249). 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引用次数: 0
摘要
背景：高流量鼻插管（HFNC）最近成为慢性阻塞性肺疾病（COPD）患者无创通气（NIV）的一种有希望的替代方案。然而，关于HFNC与NIV在慢性阻塞性肺病急性加重期（AECOPD）临床疗效的直接比较证据仍然有限且不确定。方法：系统检索PubMed、EMBASE、Cochrane Library和Web of Science，检索截至2025年1月比较HFNC和NIV在AECOPD患者中的随机对照试验（rct）。结果包括死亡率、治疗失败、插管率和治疗不耐受。结果：meta分析纳入了9项rct，共涉及786例患者。两组死亡率（I2 = 0.0%, P = 0.818; RR 1.000, 95% CI 0.638 ~ 1.569, P = 0.999）和插管率（I2 = 22.1%, P = 0.253; RR 1.401, 95% CI 0.790 ~ 2.484, P = 0.249）无显著差异。虽然HFNC显著降低了治疗不耐受（I2 = 0.0%, P = 0.976; RR = 0.145, 95% CI 0.048 ~ 0.438, P = 0.001），但与NIV相比，其治疗失败率升高的趋势不显著（I2 = 36.2%, P = 0.180; RR = 1.553, 95% CI 0.955 ~ 2.524, P = 0.076）。结论：HFNC治疗失败率高于NIV，但差异无统计学意义。两组之间的死亡率和插管率没有显著差异。
Comparison of clinical outcomes between high-flow nasal cannula and non-invasive ventilation in acute exacerbation of COPD: a meta-analysis of randomized controlled trials.
Background: High-flow nasal cannula (HFNC) has recently emerged as a promising alternative to non-invasive ventilation (NIV) for patients with chronic obstructive pulmonary disease (COPD). However, direct comparative evidence on the clinical efficacy of HFNC versus NIV in acute exacerbations of COPD (AECOPD) remains limited and inconclusive.
Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted up to January 2025 for randomized controlled trials (RCTs) comparing HFNC and NIV in AECOPD patients. Outcomes included mortality, treatment failure, intubation rates, and treatment intolerance.
Results: Nine RCTs involving 786 patients were included in the meta-analysis. No significant differences were observed in mortality (I2 = 0.0%, P = 0.818; RR 1.000, 95% CI 0.638 to 1.569, P = 0.999) or intubation rates (I2 = 22.1%, P = 0.253; RR 1.401, 95% CI 0.790 to 2.484, P = 0.249). Although HFNC significantly reduced treatment intolerance (I2 = 0.0%, P = 0.976; RR 0.145, 95% CI 0.048 to 0.438, P = 0.001), it showed a non-significant trend toward a higher treatment failure rate compared to NIV (I2 = 36.2%, P = 0.180; RR 1.553, 95% CI 0.955 to 2.524, P = 0.076).
Conclusion: HFNC therapy showed a trend towards a higher treatment failure rate compared to NIV, though the difference was not statistically significant. No significant differences were found in mortality or intubation rates between the two groups.
期刊介绍：
BMC Pulmonary Medicine is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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