O cateter nasal de alto fluxo como suporte respiratório após a extubação da população neonatal e pediátrica: uma revisão sistemática com metanálise

Abstract

The failure in the weaning process of invasive mechanical ventilation and consequently the patient's reintubation is already related to the increase in mortality rates and length of hospital stay. Therefore, many studies aim to elucidate what would be the best respiratory support after extubation of neonatal and pediatric patients. Among them, the High-flow nasal cannula (HFNC) is a new technology that proposes respiratory support through different mechanisms of action. The present study had the following starting question: does HFNC reduce reinte-gration rates, safely and effectively, compared to standard therapy (PT) in the neonatal as well as in the pediatric population? This is a systematic review guided by the recommenda-tions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The searches were performed in the databases of MEDLINE, EMBASE, Web of SCIENCE, LILACS, CENTRAL and CINAHL in July 2019 and updated in July 2020. All meta-analyzes were performed in the Review Manager® software and the presence of pub-lication bias was performed by Comprehensive Meta-Analysis®. Of the 1296 non-duplicated articles, 8 articles were included in the neonatal population (n = 1322) and 2 in the pediatric population (n = 252). There was no difference between HFNC and ST in reintubation rates on the neonatal population, as well as in the pediatric population. However, neonates (0.33; 0.24 to 0.46; p <0.00) and premature infants (0.27; 0.07 to 0.98; p = 0.05) who used HFNC were predisposed to a lower risk of nasal injury compared to CPAP. In addition, the neonatal population had a lower risk for abdominal distention when using CNAF (0.34; 0.17 to 0.68; p = 0.002). In pediatrics, there was no difference with HFNC versus conventional oxygen therapy (0.43; 0.1 to 1.92; p = 0.27). In conclusion, the HFNC was no different from ST in reintubation rates of neonates, additionally providing lower adverse risks in this population. In the pediatric population, CNAF was not different in reintubation rates when compared to ST. This review highlights that there is a gap in scientific studies in these populations that elucidate other benefits of CNAF in extubation.