Non-invasive respiratory supports and criteria for intubation in randomised trials of acute hypoxaemic respiratory failure: a systematic review and network meta-analysis.

We aimed to update a network meta-analysisof these treatments, and investigate whether the use of criteria for intubation in trials influences treatment effects on intubation or mortality.

我们的目标是更新这些治疗方法的网络荟萃分析，并调查试验中使用插管标准是否会影响治疗对插管或死亡率的效果。

Methods

For this systematic reviewand meta-analysis, we updated a literature search that was done in 2022 for the previous network meta-analysisexamining non-invasive oxygen supports for AHRF.

在这项系统评价和荟萃分析中，我们更新了2022年为之前网络荟萃分析所做的文献检索，该分析检查了AHRF的非侵入性氧支持。

We searched MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Web of Science, and PubMed databases from database inception to Nov 18, 2025, for randomised controlled trials studying adults (18 years or older) with AHRF, comparing non-invasive respiratory supports or comparing the use of non-invasive respiratory support to standard oxygen therapy (SOT).

我们从数据库创建开始到2025年11月18日，对MEDLINE、Embase、Cochrane CENTRAL、CINAHL、Web of Science和PubMed数据库进行了检索，寻找研究成人（18岁或以上）AHRF的随机对照试验，比较非侵入性呼吸支持或比较使用非侵入性呼吸支持与标准氧疗（SOT）。

We excluded trials enrolling patients already receiving invasive ventilation, trials that included invasive ventilation as an intervention, trials where the majority (>50%) of patients had congestive heart failure or chronic obstructive pulmonary disease as their primary reason for respiratory failure, and trials focusing on patients who were immediately postextubation or postoperative.

我们排除了已经接受有创通气的患者、将有创通气作为干预措施的试验、大多数 (>50%) 患者因充血性心力衰竭或慢性阻塞性肺病作为呼吸衰竭的主要原因的试验，以及专注于刚刚撤机或术后患者的试验。

Data were extracted from published reports.

数据是从已发表的报告中提取的。

We catalogued intubation criteria and performed a network meta-analysiscomparing the effects of continuous positive airway pressure (CPAP), high-flow nasal cannula (HFNC), and bilevel non-invasive positive pressure ventilation (NIPPV) on intubation and mortality, presented as odds ratios (ORs) and 95% credible intervals (CrIs) relative to SOT.

我们记录了插管标准，并进行了一项网络荟萃分析，比较了持续正压通气（CPAP）、高流量鼻导管（HFNC）和双水平非侵入性正压通气（NIPPV）对插管和死亡率的影响，结果以比值比（ORs）和95%可信区间（CrIs）表示，相对于标准治疗（SOT）而言。

We assessed risk of bias with the RoB 2 tool and certainty with the GRADE approach.

我们使用RoB 2工具评估了偏倚风险，并使用GRADE方法评估了证据的确定性。

We used network meta-regression to assess whether trials with intubation criteria found different treatment effects.

我们使用网络荟萃回归分析来评估具有插管标准的试验是否发现了不同的治疗效果。

The protocol was pre-registered on Jan 23, 2024, with Open Science Framework, https://osf.io/f8qeh.

该方案于2024年1月23日预先在开放科学框架上注册，网址为https://osf.io/f8qeh。

Results

We included 44 trials (33 from previous review, 11 newly identified) that enrolled 9704 patients.

我们纳入了44项试验（33项来自先前的综述，11项为新识别的），共招募了9704名患者。

The median proportion of participants who were female was 37% (IQR 29-45) and the median proportion male was 63% (55-71).

参与者的中位数女性比例为37%（四分位数间距29-45），男性比例的中位数为63%（55-71）。

The network for intubation included 8790 patients and 42 comparisons from 37 trials.

插管网络包括来自37项试验的8790名患者和42个比较。

The network for mortality included 8789 patients and 39 comparisons from 34 trials.

死亡率网络包括来自34项试验的8789名患者和39个比较。

Intubation criteria were present in 37 (84%) trials, and most pertained to oxygenation, ventilation, or neurological state.

37项（84%）试验中存在插管标准，大多数与氧合、通气或神经系统状态有关。

Compared with SOT, CPAP (OR 0·45, 95% CrI 0·27-0·72), HFNC (OR 0·61, 0·42-0·86), and bilevel NIPPV (OR 0·60, 0·39-0·89) probably reduce intubation (all moderate certainty).

与SOT相比，CPAP（OR 0·45，95% CrI 0·27-0·72）、HFNC（OR 0·61，0·42-0·86）和双水平NIPPV（OR 0·60，0·39-0·89）可能降低插管率（所有均为中等证据质量）。

CPAP (OR 0·73, 0·55-0·95) and HFNC (OR 0·83, 0·66-0·98) may reduce mortality compared with SOT (both low certainty), whereas bilevel NIPPV (OR 0·93, 0·71-1·17; low certainty) may not.

持续气道正压通气(CPAP)（比值比OR 0·73，95%置信区间CI 0·55-0·95）和高流量鼻导管通气(HFNC)（OR 0·83，95%CI 0·66-0·98）可能会降低与标准氧疗(SOT)相比的死亡率（两者均为低确定性证据），而双水平无创正压通气(NIPPV)（OR 0·93，95%CI 0·71-1·17；低确定性）可能不会。

Criteria for intubation were not associated with differences in treatment effects.

插管标准与治疗效果差异无关。

interpretation

Compared with SOT, CPAP, HFNC, and bilevel NIPPV probably reduce intubation, and CPAP and HFNC may reduce mortality.

与SOT相比，CPAP、HFNC和双水平NIPPV可能降低插管率，而CPAP和HFNC可能降低死亡率。

Criteria for intubation were common but were not associated with differences in treatment efficacy.

插管标准是常见的，但与治疗效果的差异无关。

These findings can guide the selection of non-invasive respiratory supports for patients, inform policymakers regarding the utility of non-invasive respiratory supports, and provide reassurance that results from trials incorporating intubation criteria likely extend to contexts where explicit intubation criteria are not used.

这些发现可以指导临床医生为患者选择非侵入性呼吸支持方式，为政策制定者提供关于非侵入性呼吸支持效用的信息，并确保在纳入插管标准的试验结果很可能适用于那些没有明确使用插管标准的情境。

funding

JP Bickell Foundation.

JP Bickell基金会。