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

Serious^a

Not serious

Not serious

Serious^b

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

Serious^b

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

Serious^b

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

Serious^b

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

Serious^a

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

Serious^c

Not serious

Serious^b

None

276

255

—

MD 1.66 hours (from −0.95 to 4.27)

⊕⊕Low

Critical

Length of hospital stay (day)

2

RCTs

Not serious

Serious^c

Not serious

Serious^b

None

228

203

—

MD 0.9 days (from −2.06 to 3.87)

⊕⊕Low

Critical

Patient dyspnea score

2

RCTs

Serious^d

Serious^c

Not serious

Not serious

None

83

85

—

MD −0.82 point (from −1.45 to −0.18)

⊕⊕Low

Critical

Patient comfort score

3

RCTs

Serious^d

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.