加拿大多伦多大学Bruno L. Ferreyro团队探讨了无创氧合策略治疗急性低氧血症性呼吸衰竭对全因死亡率的影响。该论文发表在2020年6月4日出版的《美国医学会杂志》上。

对于急性低氧血症性呼吸衰竭的患者，采用无创氧合策略（如无创通气和高流量鼻氧）治疗可能比单独使用标准氧疗更有效。

为了比较成人低氧血症性呼吸衰竭的无创氧合策略与死亡率和气管插管的相关性，研究组在MEDLINE、Embase、PubMed等大型数据库中检索从建库至2020年4月的数据，筛选出比较急性低氧血症性呼吸衰竭的成年人接受高流量鼻氧、面罩无创通气、头盔无创通气或标准氧气疗法的随机临床试验。由两名审阅者独立提取个人研究数据，并使用Cochrane偏倚风险工具对偏倚风险进行评估。

最终共纳入25项随机临床试验，涉及3804名参与者。与标准氧疗相比，采用头盔无创通气和面罩无创通气治疗均可显著降低死亡风险。头盔无创通气、面罩无创通气和高流量鼻氧均可显著降低气管插管风险。但由于插管非盲造成的偏倚风险较高。

总之，对于急性低氧血症性呼吸衰竭成年患者，与标准氧疗相比，采用无创氧合策略进行治疗可降低死亡风险。

附：英文原文

Title: Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-analysis

Author: Bruno L. Ferreyro, Federico Angriman, Laveena Munshi, Lorenzo Del Sorbo, Niall D. Ferguson, Bram Rochwerg, Michelle J. Ryu, Refik Saskin, Hannah Wunsch, Bruno R. da Costa, Damon C. Scales

Issue&Volume: 2020-06-04

Abstract: Importance  Treatment with noninvasive oxygenation strategies such as noninvasive ventilation and high-flow nasal oxygen may be more effective than standard oxygen therapy alone in patients with acute hypoxemic respiratory failure.

Objective  To compare the association of noninvasive oxygenation strategies with mortality and endotracheal intubation in adults with acute hypoxemic respiratory failure.

Data Sources  The following bibliographic databases were searched from inception until April 2020: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and LILACS. No limits were applied to language, publication year, sex, or race.

Study Selection  Randomized clinical trials enrolling adult participants with acute hypoxemic respiratory failure comparing high-flow nasal oxygen, face mask noninvasive ventilation, helmet noninvasive ventilation, or standard oxygen therapy.

Data Extraction and Synthesis  Two reviewers independently extracted individual study data and evaluated studies for risk of bias using the Cochrane Risk of Bias tool. Network meta-analyses using a bayesian framework to derive risk ratios (RRs) and risk differences along with 95% credible intervals (CrIs) were conducted. GRADE methodology was used to rate the certainty in findings.

Main Outcomes and Measures  The primary outcome was all-cause mortality up to 90 days. A secondary outcome was endotracheal intubation up to 30 days.

Results  Twenty-five randomized clinical trials (3804 participants) were included. Compared with standard oxygen, treatment with helmet noninvasive ventilation (RR, 0.40 [95% CrI, 0.24-0.63]; absolute risk difference, 0.19 [95% CrI, 0.37 to 0.09]; low certainty) and face mask noninvasive ventilation (RR, 0.83 [95% CrI, 0.68-0.99]; absolute risk difference, 0.06 [95% CrI, 0.15 to 0.01]; moderate certainty) were associated with a lower risk of mortality (21 studies [3370 patients]). Helmet noninvasive ventilation (RR, 0.26 [95% CrI, 0.14-0.46]; absolute risk difference, 0.32 [95% CrI, 0.60 to 0.16]; low certainty), face mask noninvasive ventilation (RR, 0.76 [95% CrI, 0.62-0.90]; absolute risk difference, 0.12 [95% CrI, 0.25 to 0.05]; moderate certainty) and high-flow nasal oxygen (RR, 0.76 [95% CrI, 0.55-0.99]; absolute risk difference, 0.11 [95% CrI, 0.27 to 0.01]; moderate certainty) were associated with lower risk of endotracheal intubation (25 studies [3804 patients]). The risk of bias due to lack of blinding for intubation was deemed high.

Conclusions and Relevance  In this network meta-analysis of trials of adult patients with acute hypoxemic respiratory failure, treatment with noninvasive oxygenation strategies compared with standard oxygen therapy was associated with lower risk of death. Further research is needed to better understand the relative benefits of each strategy.

DOI: 10.1001/jama.2020.9524

Source: https://jamanetwork.com/journals/jama/fullarticle/2767025