Association of Extubation Failure Rates With High-Flow Nasal Cannula, Continuous Positive Airway Pressure, and Bilevel Positive Airway Pressure vs Conventional Oxygen Therapy in Infants and Young Children: A Systematic Review and Network Meta-Analysis.

Autor: Iyer NP; Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, California.; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles., Rotta AT; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Duke University, Durham, North Carolina., Essouri S; Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada., Fioretto JR; Department of Pediatrics, Pediatric Critical Care Division, Botucatu Medical School - UNESP-Sao Paulo State University, Botucatu, Sao Paulo, Brazil., Craven HJ; Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis., Whipple EC; Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis., Ramnarayan P; Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, United Kingdom., Abu-Sultaneh S; Department of Pediatrics, Division of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis., Khemani RG; Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, California.; Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles.
Jazyk: angličtina
Zdroj: JAMA pediatrics [JAMA Pediatr] 2023 Aug 01; Vol. 177 (8), pp. 774-781.
DOI: 10.1001/jamapediatrics.2023.1478
Abstrakt: Importance: Extubation failure (EF) has been associated with worse outcomes in critically ill children. The relative efficacy of different modes of noninvasive respiratory support (NRS) to prevent EF is unknown.
Objective: To study the reported relative efficacy of different modes of NRS (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and bilevel positive airway pressure [BiPAP]) compared to conventional oxygen therapy (COT).
Data Sources: MEDLINE, Embase, and CINAHL Complete through May 2022.
Study Selection: Randomized clinical trials that enrolled critically ill children receiving invasive mechanical ventilation for more than 24 hours and compared the efficacy of different modes of postextubation NRS.
Data Extraction and Synthesis: Random-effects models were fit using a bayesian network meta-analysis framework. Between-group comparisons were estimated using odds ratios (ORs) or mean differences with 95% credible intervals (CrIs). Treatment rankings were assessed by rank probabilities and the surface under the cumulative rank curve (SUCRA).
Main Outcomes and Measures: The primary outcome was EF (reintubation within 48 to 72 hours). Secondary outcomes were treatment failure (TF, reintubation plus NRS escalation or crossover to another NRS mode), pediatric intensive care unit (PICU) mortality, PICU and hospital length of stay, abdominal distension, and nasal injury.
Results: A total of 11 615 citations were screened, and 9 randomized clinical trials with a total of 1421 participants were included. Both CPAP and HFNC were found to be more effective than COT in reducing EF and TF (CPAP: OR for EF, 0.43; 95% CrI, 0.17-1.0 and OR for TF 0.27, 95% CrI 0.11-0.57 and HFNC: OR for EF, 0.64; 95% CrI, 0.24-1.0 and OR for TF, 0.34; 95% CrI, 0.16- 0.65). CPAP had the highest likelihood of being the best intervention for both EF (SUCRA, 0.83) and TF (SUCRA, 0.91). Although not statistically significant, BiPAP was likely to be better than COT for preventing both EF and TF. Compared to COT, CPAP and BiPAP were reported as showing a modest increase (approximately 3%) in nasal injury and abdominal distension.
Conclusions and Relevance: The studies included in this systematic review and network meta-analysis found that compared with COT, EF and TF rates were lower with modest increases in abdominal distension and nasal injury. Of the modes evaluated, CPAP was associated with the lowest rates of EF and TF.
Databáze: MEDLINE