Respiratory support in the emergency department a systematic review and meta-analysis

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dc.citation.volumeEarly View
dc.contributor.authorO'Donnell J
dc.contributor.authorPirret A
dc.contributor.authorHoare K
dc.contributor.authorFenn R
dc.contributor.authorMcDonald E
dc.coverage.spatialUnited States
dc.date.accessioned2024-04-09T02:17:30Z
dc.date.accessioned2024-07-25T06:43:47Z
dc.date.available2024-03-22
dc.date.available2024-04-09T02:17:30Z
dc.date.available2024-07-25T06:43:47Z
dc.date.issued2024-03-22
dc.description.abstractBACKGROUND: An estimated 20% of emergency department (ED) patients require respiratory support (RS). Evidence suggests that nasal high flow (NHF) reduces RS need. AIMS: This review compared NHF to conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in adult ED patients. METHOD: The systematic review (SR) and meta-analysis (MA) methods reflect the Cochrane Collaboration methodology. Six databases were searched for randomized controlled trials (RCTs) comparing NHF to COT or NIV use in the ED. Three summary estimates were reported: (1) need to escalate care, (2) mortality, and (3) adverse events (AEs). RESULTS: This SR and MA included 18 RCTs (n = 1874 participants). Two of the five MA conclusions were statistically significant. Compared with COT, NHF reduced the risk of escalation by 45% (RR 0.55; 95% CI [0.33, 0.92], p = .02, NNT = 32); however, no statistically significant differences in risk of mortality (RR 1.02; 95% CI [0.68, 1.54]; p = .91) and AE (RR 0.98; 95% CI [0.61, 1.59]; p = .94) outcomes were found. Compared with NIV, NHF increased the risk of escalation by 60% (RR 1.60; 95% CI [1.10, 2.33]; p = .01); mortality risk was not statistically significant (RR 1.23, 95% CI [0.78, 1.95]; p = .37). LINKING EVIDENCE TO ACTION: Evidence-based decision-making regarding RS in the ED is challenging. ED clinicians have at times had to rely on non-ED evidence to support their practice. Compared with COT, NHF was seen to be superior and reduced the risk of escalation. Conversely, for this same outcome, NIV was superior to NHF. However, substantial clinical heterogeneity was seen in the NIV delivered. Research considering NHF versus NIV is needed. COVID-19 has exposed the research gaps and slowed the progress of ED research.
dc.description.confidentialfalse
dc.identifier.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/38517002
dc.identifier.citationO'Donnell J, Pirret A, Hoare K, Fenn R, McDonald E. (2024). Respiratory support in the emergency department a systematic review and meta-analysis.. Worldviews Evid Based Nurs. Early View.
dc.identifier.doi10.1111/wvn.12718
dc.identifier.eissn1741-6787
dc.identifier.elements-typejournal-article
dc.identifier.issn1545-102X
dc.identifier.urihttps://mro.massey.ac.nz/handle/10179/70760
dc.languageeng
dc.publisherWiley Periodicals LLC on behalf of Sigma Theta Tau International
dc.publisher.urihttps://sigmapubs.onlinelibrary.wiley.com/doi/10.1111/wvn.12718
dc.relation.isPartOfWorldviews Evid Based Nurs
dc.rights(c) 2024 The Author/s
dc.rightsCC BY 4.0
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCOVID‐19
dc.subjectemergency
dc.subjecthigh‐flow nasal cannula
dc.subjectmeta‐analysis
dc.subjectnasal high flow
dc.subjectoxygenation
dc.subjectrespiratory
dc.subjectsystematic review
dc.titleRespiratory support in the emergency department a systematic review and meta-analysis
dc.typeJournal article
pubs.elements-id487961
pubs.organisational-groupOther
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