Respiratory Support in the Emergency Department: An Updated Systematic Review and Meta-Analysis.
Jane O'Donnell, Rebecca Fenn
PMID 42410869WHAT IT FOUND
For adults needing breathing support in the ED, high-flow nasal oxygen did not clearly reduce need to escalate care versus standard oxygen, but it increased escalation risk versus non-invasive ventilation.
Mortality did not differ.
Key findings
01Compared with conventional oxygen therapy, nasal high-flow did not show a significant difference in the need to escalate care.
02Compared with non-invasive ventilation, nasal high-flow was associated with a higher risk of needing to escalate care (risk ratio 1.86).
03Mortality did not differ significantly for nasal high-flow compared with conventional oxygen therapy or non-invasive ventilation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only English-language randomized trials in emergency department adults were included, so findings may not apply to children, non-ED settings, or non-English studies. The search sensitivity was low because nasal high-flow has many names and acronyms, so relevant trials could have been missed. The review could not fully account for subgroups, and outcome data were affected by imprecision. Randomized trials could not fully blind allocation, which may bias results. The non-invasive ventilation trials used different interfaces and ventilator settings, so the nasal high-flow versus non-invasive ventilation finding should be interpreted cautiously. Heterogeneity analyses were not performed for the fixed-effect meta-analyses. An included trial excluded patients who needed urgent intubation, which may affect how the non-invasive ventilation comparison applies.
Declared interests
An unrestricted New Zealand Health Research Council grant supported the review. An author was employed by Fisher & Paykel Healthcare before 2020; the other author declared no conflicts.
The easy way to misread this
Do not conclude that nasal high-flow oxygen is superior to standard oxygen therapy or non-invasive ventilation. The need to escalate care did not differ versus conventional oxygen therapy, and it was higher versus non-invasive ventilation.