Table 2. Summary of findings: High flow nasal therapy versus non-invasive ventilation for acute hypercapnic respiratory failure.
| Patient or population: Acute hypercapnic respiratory failure patient
Setting: Acute Care Intervention: HFNT Comparison: NIV | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Interventions | MD */OR * (95%)/p-value | № of participants analyzed
(studies) |
The certainty of the evidence
(GRADE) |
Comments | |
| NIV
*
n/N * |
HFNT
*
n/N * |
|||||
|
Secondary outcome (Dichotomous data) a. Mortality rate 23 time-point: 30-day |
44/8 | 44/7 | OR 0.85 [0.28, 2.59] | 88 (1 Cohort) | ⊕⊕OO
Low 3 |
|
| b. Mortality rate
36
time-point: in-hospital mortality |
39/6 | 40/2 | OR 0.29 [0.05, 1.53] | 80 (1RCT) | ⊕⊕⊕O
Moderate 2 |
The study didn’t provide the time-point for mortality. |
| c. Intubation rate
36
time-points: 6 hours |
39/1 | 40/1 | OR 0.97 [0.06, 16.14] | 80 (1RCT) | ⊕⊕⊕O
Moderate 2 |
|
| d. Intubation rate
34
time-point: 72 hours |
31/5 | 34/2 | OR 0.33 [0.06, 1.81] | 65 (1 RCT) | ⊕⊕⊕O
Moderate 2 |
|
| e. Intubation rate
23
time-points: 30-day |
44/12 | 44/11 | OR 0.89 [0.34, 2.30] | 88 (1 Cohort) | ⊕⊕OO
Low 3 |
|
| f. Dysponea 34, 36 | - | - | - | 145 (2RCTs) | - | Dyspnoea was measured by 2 studies at various time points. It was assessed by modified Borg. |
| g. Patient comfort 35, 36 | - | - | - | 245 (2 RCTs) | - | Comfort was measured by 2 studies at various time points. It was assessed by a self-designed survey and a 10-point numerical rating scale. |
| GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
| Explanation
1- Downgraded for indirectness because of the study population 2- Downgraded for imprecision for a wide confidence interval, the small sample size 3- Downgraded for study design (non-RCT) 4- Downgraded for risk of bias | ||||||
*
Abbreviations: HFNT, High flow nasal therapy; IQR, Interquartile range; MD, mean difference; n/N, Number of patients NIV, Non-invasive ventilation; OR, Odd ratio; SD, Standard deviation.