Treatment of acute hypoxemic respiratory failure with noninvasive ventilation using a helmet or face mask led to fewer deaths

Référence

Ferreyro BL, Angriman F, Munshi L, et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure. JAMA 2020;324(1):1-12.

Sommaire

Noninvasive oxygenation strategies include standard oxygen therapy at flow rates of 15 L per minute or less, noninvasive ventilation via face mask or helmet, and high-flow oxygen delivery via nasal cannula. In this study, investigators compared these different oxygenation strategies and their associations with mortality and need for endotracheal intubation. The authors searched multiple databases, including MEDLINE, EMBASE, and the Cochrane Central Register, to find randomized controlled trials that enrolled adult patients with acute hypoxemic respiratory failure and compared the different oxygenation strategies. They excluded studies that focused on patients following cardiovascular surgery, patients with acute exacerbations of chronic obstructive pulmonary disease and congestive heart failure, and patients in the immediate post-extubation period. Two reviewers independently extracted and evaluated studies for risk of bias. Of the 25 included studies, 21 reported on mortality. Of these, 16 had low risk of bias. As compared with standard oxygen therapy, both helmet and face mask noninvasive ventilation led to significantly decreased mortality (helmet: relative risk [RR] 0.40, 95% CI 0.24 - 0.63; face mask: RR 0.83, 0.68 - 0.99), while high-flow oxygen did not. All 25 studies reported on endotracheal intubation. Risk of bias was high for 7 studies and unclear for 18 studies. All 3 strategies resulted in reduced intubations as compared with standard oxygen therapy (helmet: RR 0.26, 0.14 - 0.46; face mask: RR 0.76, 0.62 - 0.90; high-flow oxygen: RR 0.76, 0.55 - 0.99). Although noninvasive ventilation by helmet had the best probability of reducing mortality and intubation among all the strategies, the quality of the evidence using helmets was low.