Noninvasive oxygenation strategies in adult patients with acute respiratory failure: a protocol for a systematic review and network meta-analysis.

Ferreyro, Bruno L; Angriman, Federico; Munshi, Laveena; Del Sorbo, Lorenzo; Ferguson, Niall D; Rochwerg, Bram; Ryu, Michelle J; Saskin, Refik; Wunsch, Hannah; Da Costa, Bruno R.; Scales, Damon C (2020). Noninvasive oxygenation strategies in adult patients with acute respiratory failure: a protocol for a systematic review and network meta-analysis. Systematic Reviews, 9(1), p. 95. BioMed Central 10.1186/s13643-020-01363-0

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BACKGROUND

Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and is associated with high mortality. Noninvasive oxygenation strategies such as high-flow nasal cannula, standard oxygen therapy, and noninvasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network meta-analysis is to summarize the evidence and compare the effect of noninvasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure.

METHODS

We will search key databases for randomized controlled trials assessing the effect of noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology.

DISCUSSION

This study will help to guide clinical decision-making when caring for adult patients with acute hypoxemic respiratory failure and improve our understanding of the limitations of the available literature assessing noninvasive oxygenation strategies in acute hypoxemic respiratory failure.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019121755.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Da Costa, Bruno

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2046-4053

Publisher:

BioMed Central

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

08 May 2020 20:42

Last Modified:

14 Mar 2021 01:53

Publisher DOI:

10.1186/s13643-020-01363-0

PubMed ID:

32336293

Uncontrolled Keywords:

Hypoxia Noninvasive ventilation Oxygen Oxygen inhalation therapy Respiratory insufficiency

BORIS DOI:

10.7892/boris.143932

URI:

https://boris.unibe.ch/id/eprint/143932

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