High flow nasal therapy in immunocompromised patients with acute respiratory failure: A systematic review and meta-analysis

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Purpose:The role of high-flow nasal therapy (HFNT) as compared to conventional oxygen therapy (COT) in immunocompromised patients admitted to intensive care unit (ICU) with acute respiratory failure (ARF) remains unclear. We conducted a systematic review and meta-analysis in order to address this issue.Methods:We searched PubMed, Medline and Embase until November 7th, 2018. Randomized controlled trials (RCTs), non-randomized prospective and retrospective evidence were selected. Observational studies were considered for sensitivity analysis. Primary outcome was mortality rate; intubation rate was a secondary outcome.Results:We included four studies in the primary analysis: one RCT, two RCT's post-hoc analyses and one retrospective study. We found no significant difference in short-term mortality comparing HFNT vs. COT: 1) ICU: n=872 patients, odds ratio (OR)=0.80 [0.44,1.45], p=0.46, I2=30%, p=0.24; 2) 28-day: n=996 patients, OR=0.79 [0.45,1.38], p=0.40, I2=52%, p=0.12). Conversely, we found a reduction of intubation rate in the HFNT group (n=1052 patients, OR=0.74 [0.55,0.98], p=0.03, I2=7%, p=0.36). The inclusion of one observational study for sensitivity analysis did not grossly change results.Conclusions:We found no benefit of HFNT over COT on mortality in immunocompromised patients with ARF. However, HFNT was associated with a lower intubation rate warranting further research.HIGHLIGHTSImmunocompromised patients (IP) are at high risk of acute respiratory failure (ARF)In such cases high-flow nasal therapy (HFNT) could be a valid treatment optionOur study did not find a reduction of mortality using HFNT vs. oxygen in IP with ARFWe found a reduction of intubation rate using HFNT vs. oxygen in IP with ARF

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