Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials.

Several strategies for preoxygenation exist, including facemask oxygen, high-flow nasal cannula (HFNC), and non-invasive positive pressure ventilation (NIPPV).

存在多种预氧合策略，包括面罩供氧、高流量鼻导管(HFNC)和无创正压通气(NIPPV)。

However, the comparative efficacy of these strategies remains largely uncertain.

然而，这些策略的比较效果在很大程度上仍然不确定。

We aimed to compare the efficacy and safety of HFNC, NIPPV, and facemask oxygen for preoxygenation of patients who are critically ill requiring tracheal intubation.

我们的目标是比较高流量鼻导管氧疗（HFNC）、无创正压通气（NIPPV）和面罩供氧在为需要气管插管的危重病人进行预氧合时的疗效和安全性。

Methods

In this systematic reviewand network meta-analysis, we searched Embase, MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials for randomised clinical trials published from database inception until Oct 31, 2024, with no language restrictions.

在这项系统评价和网络荟萃分析中，我们检索了Embase、MEDLINE、Web of Science、Scopus和Cochrane中央对照试验登记处，从数据库开始直到2024年10月31日发表的随机临床试验，没有语言限制。

We included randomised controlled trials that compared HFNC versus NIPPV, HFNC versus facemask oxygen, or NIPPV versus facemask oxygen in adult patients (age ≥18 years) who were critically ill requiring intubation in the intensive care or emergency department setting.

我们纳入了比较高流量鼻导管氧疗（HFNC）与非侵入性通气（NIPPV）、HFNC与面罩氧疗，或NIPPV与面罩氧疗的随机对照试验，这些试验针对的是在重症监护或急诊科需要插管的成人患者（年龄≥18岁）。

We had no additional eligibility criteria for our network meta-analysis.

我们的网络荟萃分析没有额外的纳入标准。

We used Covidence software to screen eligible trials.

我们使用Covidence软件来筛选符合条件的试验。

Two reviewers independently screened trials for titles and abstracts, and then subsequently screened full-text reports.

两位评审员独立地对试验的标题和摘要进行筛选，然后随后对全文报告进行筛选。

Discrepancies were resolved by discussion or a third party adjudicator.

如有分歧，通过讨论或第三方裁决者解决。

Summary-level data were extracted manually using a structured data collection form.

使用结构化数据收集表手动提取摘要级数据。

Outcomes of interest were hypoxaemia during intubation, successful intubation on the first attempt, serious adverse events, and all-cause mortality.

感兴趣的结局包括插管期间的低氧血症、首次尝试插管成功、严重不良事件和全因死亡率。

We performed a frequentist random-effects network meta-analysis.

我们进行了一项频率随机效应网络荟萃分析。

We assessed the risk of bias using the modified Cochrane tool (RoB 2.0) and the certainty of evidence using the GRADE approach.

我们使用改良的Cochrane工具（RoB 2.0）评估偏倚风险，并使用GRADE方法评估证据的确定性。

The protocol is registered on the Open Science Framework.

该方案已在开放科学框架上注册。

Results

We initially identified 6900 records, of which 48 were assessed via full-text screening, and 15 eligible studies with 3420 patients were included in our systematic reviewand network meta-analysis.

我们最初识别出6900条记录，其中48条通过全文筛查进行了评估，最终有15项符合条件的研究，包括3420名患者，被纳入我们的系统评价和网络荟萃分析。

Findings suggested that use of NIPPV for preoxygenation probably reduces the incidenceof hypoxaemia during intubation versus HFNC (relative risk 0·73 [95% CI 0·55-0·98]; p=0·032; moderate certainty) and reduces the incidenceof hypoxaemia versus facemask oxygen (0·51 [0·39-0·65]; p<0·0001; high certainty).

研究结果表明，与HFNC相比，使用NIPPV进行预氧合可能降低了插管期间低氧血症的发生率（相对风险0.73 [95%置信区间0.55-0.98]；p=0.032；中等确定性），并且与面罩供氧相比，降低了低氧血症的发生率（0.51 [0.39-0.65]；p<0.0001；高确定性）。

HFNC for preoxygenation reduces the incidenceof hypoxaemia during intubation versus facemask oxygen (0·69 [0·54-0·88]; p=0·0064; high certainty).

使用HFNC进行预氧合可以降低插管期间低氧血症的发生率，与面罩供氧相比（0.69 [0.54-0.88]；p=0.0064；高确定性）。

None of the preoxygenation strategies affected the incidenceof successful intubation on the first attempt (all low certainty).

各种预氧合策略均未影响首次尝试插管的成功率（所有研究的证据质量均较低）。

None of the preoxygenation strategies appeared to affect all-cause mortality (very low-to-moderate certainty).

各种预氧合策略似乎均未影响全因死亡率（证据质量非常低至中等）。

NIPPV probably reduces the risk of serious adverse events versus facemask oxygen (0·30 [0·12-0·77]; p=0·011; moderate certainty) and might reduce the risk of serious adverse events versus HFNC (0·32 [0·11-0·91]; p=0·035; low certainty).

与面罩供氧相比，NIPPV可能降低了严重不良事件的风险（0·30 [0·12-0·77]；p=0·011；中等确定性），并且可能降低了与HFNC相比的严重不良事件风险（0·32 [0·11-0·91]；p=0·035；低确定性）。

HFNC might not reduce the risk of serious adverse events versus facemask oxygen (0·95 [0·60-1·51]; p=0·83; low certainty).

与面罩供氧相比，HFNC可能并未降低严重不良事件的风险（0·95 [0·60-1·51]；p=0·83；低确定性）。

interpretation

Preoxygenation with NIPPV or HFNC rather than facemask oxygen might prevent hypoxaemia during tracheal intubation of adults who are critically ill.

对于危重病成人患者，使用NIPPV或HFNC进行预氧合，而不是面罩供氧，可能会预防气管插管期间的低氧血症。

Compared with HFNC, NIPPV probably decreases the incidenceof hypoxaemia during intubation.

与HFNC相比，NIPPV可能会降低插管期间低氧血症的发生率。

Our findings will inform updated international guidelines on preoxygenation.

我们的发现将为更新的国际预氧合指南提供信息。

funding

None.

无。