High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis

Xu, Zhiheng; Li, Yimin; Zhou, Jianmeng; Li, Xi; Huang, Yongbo; Liu, Xiaoqing; Burns, Karen E. A.; Zhong, Nanshan; Zhang, Haibo

doi:10.1186/s12931-018-0908-7

Table 2 The GRADE Quality Assessment

From: High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis

Quality assessment							No of patients		Effect		Quality	Importance
No of studies	Design	Limitations	Inconsistency	Indirectness	Imprecision	Other considerations	HFNC	COT/NIV	Relative (95% CI)	Absolute	Quality	Importance
Intubation rate of HFNC vs. COT as a primary mode
5	randomised trials	serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	reporting bias^b	46/434 (10.6%)	50/397 (12.6%)	OR 0.74 (0.45 to 1.21)	30 fewer per 1000 (from 65 fewer to 23 more)	⊕ ⊕ ΟΟ LOW	CRITICAL
Reintubation rate of HFNC vs. COT after extubation
8	randomised trials	serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	reporting bias^b strong association^c	63/839 (7.5%)	123/833 (14.8%)	OR 0.47 (0.29 to 0.76)	72 fewer per 1000 (from 31 fewer to 100 fewer)	⊕ ⊕ ⊕Ο MODERATE	CRITICAL
Intubation rate of HFNC vs. NIV as a primary mode
2	randomised trials	serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	reporting bias^d	47/210 (22.4%)	68/210 (32.4%)	OR 0.57 (0.36 to 0.92)	109 fewer per 1000 (from 18 fewer to 173 more)	⊕ ⊕ ΟΟ LOW	CRITICAL
Reintubation rate of HFNC vs. NIV after extubation
2	randomised trials	serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	reporting bias^d	118/704 (16.8%)	123/730 (16.8%)	OR 1.00 (0.76 to 1.32)	0 fewer per 1000 (from 35 fewer to 43 more)	⊕ ⊕ ΟΟ LOW	CRITICAL
Treatment failure of HFNC vs. COT as a primary mode
5	randomised trials	serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	reporting bias^b	58/434 (13.4%)	71/397 (17.9%)	OR 0.65 (0.43 to 0.98)	55 fewer per 1000 (from 3 fewer to 93 fewer)	⊕ ⊕ ΟΟ LOW	CRITICAL
Treatment failure of HFNC vs. COT after extubation
8	randomised trials	serious^a	serious inconsistency^e	no serious indirectness	no serious imprecision	reporting bias^bstrong association^c	108/893 (12.9%)	192/833 (23%)	OR 0.43 (0.25 to 0.73)	116 fewer per 1000 (from 51 fewer to 161 fewer)	⊕ ⊕ ⊕Ο MODERATE	CRITICAL

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate
CI Confidence interval, OR Odds ratio
^aLack of blinding
^bFunnel plot showed potential publication bias when HFNC vs. COT
^cOR < 0.5
^dFunnel plot showed potential publication bias when HFNC vs. NIV
^eI² = 66%

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ISSN: 1465-993X

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