Figures
- FIGURE 1
PRISMA flowchart. RCT: randomised controlled trial.
- FIGURE 2
Risk of bias assessments.
- FIGURE 3
Impact of overall, “therapeutic” and “prophylactic” noninvasive respiratory support on primary outcome (re-intubation). COT: conventional oxygen therapy; HFNO: high-flow nasal oxygen; NIV: noninvasive ventilation.
- FIGURE 4
Impact of “prophylactic” noninvasive respiratory support on predefined subgroups (re-intubation). COT: conventional oxygen therapy; HFNO: high-flow nasal oxygen; NIV: noninvasive ventilation.
Tables
- TABLE 1
Network estimates evaluating the impact of the interventions on primary and secondary outcomes in the overall population
Comparison MD or OR (95% CI) p-value I2 (%) τ2 K GRADE# Classification of intervention¶ Re-intubation 36 0.120 HFNO versus COT 0.60 (0.43–0.84) 0.003 11 Moderatea Large beneficial effect NIV versus COT 0.61 (0.46–0.81) <0.001 15 Moderatea Large beneficial effect NIV versus HFNO 0.98 (0.69–1.40) 0.844 5 Moderateb VAP 0 0 HFNO versus COT 0.36 (0.18–0.71) 0.003 3 Moderatea Large beneficial effect NIV versus COT 0.49 (0.34–0.73) <0.001 7 Moderatea Large beneficial effect NIV versus HFNO 0.74 (0.39–1.38) 0.855 1 Moderateb Discomfort 49 0.493 HFNO versus COT 2.60 (0.79–8.60) 0.117 7 Lowa,b Large harmful effect NIV versus COT 13.14 (5.94–29.04) <0.001 1 Moderatea Large harmful effect NIV versus HFNO 0.20 (0.06–0.62) 0.050 1 High ICU mortality 6 0.017 HFNO versus COT 0.81 (0.44–1.48) 0.489 5 Lowa,b Small beneficial effect NIV versus COT 0.64 (0.39–1.05) 0.075 8 Moderatea Large beneficial effect NIV versus HFNO 1.26 (0.63–2.52) 0.834 1 Lowa,b Hospital mortality 6 0.017 HFNO versus COT 0.86 (0.62–1.18) 0.431 5 Moderatea Small beneficial effect NIV versus COT 0.64 (0.47–0.87) 0.004 11 Moderatea Large beneficial effect NIV versus HFNO 1.35 (0.97–1.86) 0.194 4 Moderateb ICU length of stay 87 1.048 HFNO versus COT −0.12 (−0.85–0.61) 0.741 9 Very lowa,b,c,d Trivial beneficial effect NIV versus COT −0.72 (−1.44–0.00) 0.049 14 Very lowa,c,d Small beneficial effect NIV versus HFNO 0.60 (−0.33–1.53) 0.320 4 Very lowb,c,d Hospital length of stay 86 2.230 HFNO versus COT −0.04 (−1.27–1.18) 0.264 8 Very lowa,b,c Trivial beneficial effect NIV versus COT −2.38 (−3.69– −1.07) <0.001 10 Lowa,c Large beneficial effect NIV versus HFNO 2.34 (0.80–3.88) 0.189 3 Very lowa,b,c Time to re-intubation 89 87.485 HFNO versus COT 2.99 (−8.13–14.10) 0.564 3 Very lowa,b,c Trivial harmful effect NIV versus COT 9.17 (−1.06–19.40) 0.105 4 Very lowa,b,c Small harmful effect NIV versus HFNO −6.18 (−18.86–6.5) 0.371 1 Very lowa,b,c MD: mean difference; OR: odds ratio; τ2 and I2: loop heterogeneity; K: number of studies providing direct evidence; GRADE: Grading of Recommendations Assessment, Development and Evaluations; HFNO: high-flow nasal oxygen; COT: conventional oxygen therapy; NIV: noninvasive ventilation; VAP: ventilator-associated pneumonia; ICU: intensive care unit. #: GRADE certainty of evidence: a: lowered one level for risk of bias; b: lowered one level for imprecision as confidence intervals do not allow excluding harm; c: lowered one level for inconsistency; d: lowered one level for incoherence. ¶: for dichotomous outcome variables, large intervention effects were considered for OR >1.3 or <0.7, moderate intervention effects for 1.2<OR≤1.3 or 0.7≤OR<0.8, small intervention effects for 1.1<OR≤1.2 or 0.8≤OR<0.9 and trivial intervention effects for 1.0<OR≤1.1 or 0.9≤OR<1.0; for length of stay, large intervention effects were considered for MD>2, moderate intervention effects for 1<MD≤2, small intervention effects for 0.5<MD≤1 and trivial intervention effects for 0<MD≤0.5; for time to re-intubation, large intervention effects were considered for MD>24, moderate intervention effects for 12<MD≤24, small intervention effects for 6<MD≤12 and trivial intervention effects for 0<MD≤6. COT was considered as the reference intervention. Bold indicates p<0.05.
Supplementary Material
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Supplementary material ERR-0196-2022.supplement
