高流量鼻导管与标准氧疗用于成人急性低氧性呼吸衰竭：一项系统评价和荟萃分析，结合试验序贯分析和GRADE评估。
摘要
背景：高流量鼻导管（HFNC）广泛用作成人急性低氧性呼吸衰竭（AHRF）的早期呼吸支持策略。尽管HFNC可能降低气管插管的风险，但现有证据是否足够成熟以及这种潜在益处能否转化为生存率的改善仍不确定。我们进行了一项系统评价和荟萃分析，结合试验序贯分析（TSA）和GRADE评估，以比较HFNC与标准氧疗（SOT）在成人AHRF中的效果。…
正文 待译
BACKGROUND: High-flow nasal cannula (HFNC) is widely used as an early respiratory support strategy for adults with acute hypoxemic respiratory failure (AHRF). Although HFNC may reduce the risk of endotracheal intubation, it remains uncertain whether the available evidence is sufficiently mature and whether this potential benefit translates into improved survival. We performed a systematic review and meta-analysis with trial sequential analysis (TSA) and GRADE assessment to assess HFNC versus standard oxygen therapy (SOT) in adult AHRF. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to March 31, 2026. Randomized controlled trials (RCTs) of HFNC versus SOT in adults with AHRF were included. The primary and secondary outcomes were endotracheal intubation and all-cause mortality, respectively. For each dichotomous outcome, the risk ratio (RR) with a 95% confidence interval (CI) was pooled using a random-effects model. Prespecified subgroup analyses were performed. TSA was performed for intubation, and evidence certainty was assessed using GRADE. RESULTS: Ten independent RCTs reported across 11 publications were included. Compared with SOT, HFNC was associated with a lower risk of endotracheal intubation (RR, 0.85; 95% CI, 0.77-0.93; P < 0.01; I² = 40%), but did not reduce all-cause mortality (RR, 1.01; 95% CI, 0.88-1.16; P = 0.85; I² = 0%). Subgroup analyses suggested a lower intubation risk with HFNC among non-immunocompromised patients, patients with COVID-19, and those with baseline PaO₂/FiO₂ ≤ 200 mmHg, although no statistically significant subgroup interactions were observed. In the primary TSA, the accrued sample size represented only 36.8% of the diversity-adjusted required information size. The cumulative Z-curve crossed the conventional significance boundary, but not the trial sequential monitoring boundary. TSA sensitivity analyses yielded consistent findings, indicating that current evidence remains inconclusive. GRADE certainty was low for endotracheal intubation and moderate for all-cause mortality. CONCLUSIONS: HFNC may reduce the risk of endotracheal intubation compared with SOT in adults with AHRF, but a survival benefit has not been demonstrated.
English
BACKGROUND: High-flow nasal cannula (HFNC) is widely used as an early respiratory support strategy for adults with acute hypoxemic respiratory failure (AHRF). Although HFNC may reduce the risk of endotracheal intubation, it remains uncertain whether the available evidence is sufficiently mature and whether this potential benefit translates into improved survival. We performed a systematic review and meta-analysis with trial sequential analysis (TSA) and GRADE assessment to assess HFNC versus standard oxygen therapy (SOT) in adult AHRF.…