A comparative analysis of non-invasive respiratory support modalities in the treatment of acute hypercapnic respiratory failure: a network meta-analysis.

AIM: The purpose of this study is to compare different non-invasive respiratory support methods for the treatment of acute hypercapnic respiratory failure (AHRF).

METHODS

The network meta-analysis was conducted based on studies from PubMed, Embase, the Cochrane Library, and Web of Science, from their inception to September 10, 2024. The outcomes was treatment failure, all-cause mortality, intubation, dyspnea score, length of stay in hospital, respiratory rate, arterial carbon dioxide partial pressure (PaCO2), and complications. The results of both direct and indirect comparisons were quantitatively assessed using weighted mean differences or relative risks with their respective 95% confidence intervals, and graphically depicted in forest plots. Additionally, the rank probabilities were presented, demonstrating the likelihood of each non-invasive respiratory support method being the most effective across various measured outcomes.

RESULTS

Nineteen studies (2,022 participants) were included. The results indicated that the probability of treatment failure with face mask non-invasive ventilation (NIV) was lower than that of high-flow nasal cannula (HFNC) (RR: 1.42, 95% CI: 1.06, 1.93) and conventional oxygen treatment (COT) (RR: 1.87, 95% CI: 1.16, 3.03). Face mask NIV demonstrated superior performance in dyspnea score and PaCO2 compared to HFNC, helmet NIV, and COT. The length of stay in the hospital for face mask NIV was relatively longer compared to HFNC (WMD: -0.73, 95% CI: -1.35, -0.10) and COT (WMD: -1.09, 95% CI: -2.00, -0.18), and the probability of complications was higher than with HFNC. The rank probability suggested that COT had the lowest likelihood of intubation and all-cause mortality, while helmet NIV may have the best effect on improving respiratory rate.

CONCLUSION

Concerning treatment failure, dyspnea score, and PaCO2 improvement in patients with AHRF, face mask NIV may outperform other methods. For selected patients with AHRF, face mask NIV might be considered for potential first-line method. This study provides a certain level of evidence-based support for the management and treatment of AHRF, but more research is still needed in the future to determine the optimal non-invasive respiratory support method for treating patients with AHRF. In clinic, the efficacy of face mask NIV for better outcomes in patients with AHRH still requires validation.