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High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Acute Heart Failure: a meta-analysis
Session:
Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker:
Joana Guimarães
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Joana Guimarães; Ana Rita Gomes; Carolina Saleiro; Diana Campos; Rogério Teixeira; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">Background: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">High-Flow Nasal Cannula (HFNC) can deliver high oxygen (O2) flow rates, with a low level of positive end-expiration pressure; being an alternative to non-invasive ventilation in patients not able to tolerate it. While non-invasive ventilation in acute heart failure (AHF) patients has shown to reduce the need for endotracheal intubation, the role of HFNC in this setting is not well stablished. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Aim: </span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">T</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">his meta-analysis examined the efficacy of HFNC versus conventional </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">O2 </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">therapy in hypoxemic patients with </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">AHF</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">Methods: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">We searched MEDLINE, Google Scholar and the Cochrane Library databases using the key terms “HFNC” and “AHF ” without language or date restriction. </span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Articles were considered for inclusion in the analysis if they comprised a population of hypoxemic AHF patients submitted to treatment either with HFNC or </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">conventional O2 therapy. </span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">The</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> primary endpoint</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> was a composite for</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> the need of endotracheal intubation </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">or </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">death. Se</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">condary endpoints included respiratory rate and oxygen saturation 60 minutes after the initiation of treatment. Pooled mean differences and pooled odds ratios (OR) </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">and </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">their </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">95% confidence intervals (CI) were estimated based on a random effects meta</span></span><span style="font-size:10pt"><span style="font-family:"Cambria Math",serif">-</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">analysis, obtained from the pooled adjusted means and standard deviations, and OR of primary studies.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Results: </span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">T</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">hree</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> studies including </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">307</span></span> <span style="font-size:10pt"><span style="font-family:Arial,sans-serif">patients</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> were included </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">(</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">mean </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">age</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> 73</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">±11</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> years old,</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> 59% female gender)</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">.</span></span> <span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Two studies were randomized controlled trials</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> (1,2)</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> and the other study was a prospective cohort</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> (3)</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">. </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">Of the total 307 patients included, 159 received HFNC treatment</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20"> and there were 11 pooled adverse events (</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">endotracheal intubation [n=7]</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20"> and death</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20"> [n=4]</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">). </span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">HFNC did not reduce the composite endpoint (pooled OR: 0.78, 95% CI: 0.15–3.95, I</span></span></span><sup><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">2</span></span></span></sup><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">=27%) compared to conventional O2 therapy; </span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">neither</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> reduced</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> the rates of</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">endotracheal </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">intubation (pooled OR: 0.69, 95% CI: 0.15–3.29, I</span></span></span><sup><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">2</span></span></span></sup><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">=0%) or death (pooled OR: 0.84, 95% CI: 0.12–6.02, I</span></span></span><sup><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">2</span></span></span></sup><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:#231f20">=2%</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">)</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">, when analyzed in isolation</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">.</span></span> <span style="font-size:10pt"><span style="font-family:Arial,sans-serif">There was no significant heterogeneity observed between these studies</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">.</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> The </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">pooled data</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> for </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">respiratory rate</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">showed an overall weighted raw mean difference of -</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">3.16 cycles per minute</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> (95%</span></span> <span style="font-size:10pt"><span style="font-family:Arial,sans-serif">CI: CI -4.05, -2.27, P<0.001) favoring </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">HFNC</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">. There was </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">no</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> heterogeneity (I2 =</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">0%</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">).</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> For O2 saturation, the standardized mean difference was 0.97% (</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">95% CI 0.31, 1.63, P=0.004</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">) higher for the HFNC (</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">I<sup>2</sup> 89%</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">Conclusion: </span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">According to our data, HFNC significantly improved oxygenation and decreased the respiratory rate in patients with acute heart failure</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">. N</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">o</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> significant</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> effect on endotracheal intubation or death rates were </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">observed</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">.</span></span></span></span></span></p>
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