经鼻高流量氧疗用于拔管后患者疗效的系统评价再评价

目的 通过检索经鼻高流量氧疗应用于拔管后患者的相关系统评价或meta分析,对纳入研究的方法学质量和证据等级进行评价,以获得最佳证据,从而比较高流量氧疗与其他方式在拔管后患者中的有效性和安全性,以期为经鼻高流量氧疗在危重患者未来的研究重点提供参考.方法 计算机检索The Cochrane Library、PubMed、M...

The efficacy of high-flow nasal cannula oxygen therapy for patients after extubation: an overview of systematic reviews

  Objective  The aim of this paper was to evaluate the methodological quality and of evidence level for the best evidence, to compare the efficacy and safety of high-flow oxygen therapy with other therapy methods in patients after extubation, and provide reference for the future research priorities of high-flow oxygen therapy in critically ill patients through retrieving systematic review or meta-analysis of patients who were treated with high-flow nasal cannula oxygen therapy after extubation.  Methods  The Cochrane Library, PubMed, Medline, CNKI, CBM, WANFANG and VIP databases were electronically searched to collect systematic reviews or meta-analysis on the application of high-flow nasal cannula oxygen therapy for the patients after extubation. The retrieval time is limited to February 2020 from the time of database construction. Two researchers independently screened literature, and extracted data AMSTAR 2 scale and GRADE system were used to evaluate the methodological quality and evidence quality of the included literature.  Results  A total of 11 systematic reviews/meta-analyses were included. Eight articles compared high-flow oxygen therapy with non-invasive positive pressure ventilation and traditional oxygen therapy, and three articles compared the efficacy of high-flow oxygen therapy with traditional oxygen therapy only. The methodological quality evaluation by AMSTAR 2 was generally low, one study was low and 10 was extremely low. GRADE evaluation results showed that among the 78 evidence level outcome, 6 were high quality, 37 were intermediate quality, 29 were low quality and 6 were extremely low quality. Most studies have shown that the rate of re-intubation in patients with extubation using nasal high-flow oxygen therapy is lower than that of traditional oxygen therapy and similar to non-invasive positive pressure ventilation.  Conclusion  High-flow nasal cannula oxygen therapy can reduce the reintubation rate of patients after extubation and can be used as an alternative to non-invasive positive pressure ventilation under certain conditions. However, the quality of the methodology included in the study is low, and the quality of evidence is average. Therefore, it is recommended to carry out higher quality studies to explore the application of high-flow oxygen therapy in critically ill patients.