Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study
Table 2
The summary of outcomes and GRADE quality assessments.
Quality assessment
No of patients
Effect
Quality
Importance
No. of studies
Design
Risk of bias
Inconsistency
Indirectness
Imprecision
Other consideration
HFNC
COT
Relative RR (95% CI)
Absolute (95% CI)
Intubation rate
4
RCTs
Seriousa
Not serious
Not serious
Seriousb
None
10/296 (3.4%)
17/275 (6.2%)
0.53(0.26–1.09)
−32 per 1000 (from −69 to 4)
⊕⊕Low
Critical
Mortality rate
2
RCTs
Not serious
Not serious
Not serious
Seriousb
None
36/228 (15.8%)
24/203 (11.8%)
1.25(0.79–1.99)
32 per 1000 (from −32 to 95)
⊕⊕⊕Moderate
Critical
ICU admission rate
2
RCTs
Not serious
Not serious
Not serious
Seriousb
None
17/213 (8%)
15/190 (7.9%)
1.11(0.58–2.12)
8 per 1000 (from −43 to 59)
⊕⊕⊕Moderate
Critical
ED discharge rate
2
RCTs
Not serious
Not serious
Not serious
Seriousb
None
23/111 (20.7%)
23/117 (19.7%)
1.04(0.63–1.72)
8 per 1000 (from −93 to 109)
⊕⊕⊕Moderate
Critical
Need for escalation
4
RCTs
Seriousa
Not serious
Not serious
Not serious
None
13/296 (4.4%)
29/275 (10.5%)
0.41(0.22–0.78)
−62 per 1000 (from −105 to −19)
⊕⊕⊕Moderate
Critical
Length of ED stay (hour)
3
RCTs
Not serious
Seriousc
Not serious
Seriousb
None
276
255
—
MD 1.66 hours (from −0.95 to 4.27)
⊕⊕Low
Critical
Length of hospital stay (day)
2
RCTs
Not serious
Seriousc
Not serious
Seriousb
None
228
203
—
MD 0.9 days (from −2.06 to 3.87)
⊕⊕Low
Critical
Patient dyspnea score
2
RCTs
Seriousd
Seriousc
Not serious
Not serious
None
83
85
—
MD −0.82 point (from −1.45 to −0.18)
⊕⊕Low
Critical
Patient comfort score
3
RCTs
Seriousd
Not serious
Not serious
Not serious
None
131
137
—
SMD −0.76 SD (from −1.01 to −0.51)
⊕⊕⊕Moderate
Critical
RCT, randomized controlled trial; HFNC, high-flow nasal cannula; COT, conventional oxygen therapy; CI, confidence interval; RR, risk ratio; MD, mean difference; SMD, standardized mean difference. aAll inclusion trials lacked blinding (performance bias), so escalation or intubation may be subjective. bInsufficient evidence of clear benefit or harm because of a wide CI. cSignificant heterogeneity among the included trials (I2 > 50%). dSubjective outcome. ⊕, very low quality; ⊕⊕, low quality; ⊕⊕⊕, moderate quality; ⊕⊕⊕⊕, high quality.