CANCARE RESEARCH
Explore previously published research highlights by topic, study type or publication date.
An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Comparing High-Flow Nasal Cannula Therapy and Conventional Oxygen Therapy in Adult Patients Post-Cardiac Surgery: A Systematic Review and Meta-Analysis.
Clinical takeaway High-flow oxygen after cardiac surgery may reduce escalation of respiratory support, but the reported delirium signal warrants attention. The pooled findings do not establish a mortality or intubation benefit.
Summary & abstract
Study summary
This systematic review pooled 11 randomized trials involving 2473 adults recovering from cardiac surgery, comparing high-flow nasal cannula with conventional oxygen therapy. High-flow therapy reduced escalation of respiratory support (RR 0.71; 95% CI 0.55–0.93). However, delirium was more frequent with high-flow therapy (RR 3.63; 95% CI 1.80–7.30). Oxygenation and forced expiratory volume in 1 second improved, but there were no statistically significant differences in intubation, overall mortality, hospital or intensive care unit length of stay, or postoperative atrial fibrillation.
Study limitation: The abstract provides no absolute event rates or outcome-specific trial counts, limiting assessment of benefit magnitude and the delirium signal.
Published abstract
BACKGROUND: Cardiac surgery with cardiopulmonary bypass structurally alters respiratory mechanics and carries a substantial risk of postoperative morbidity. Historically, patients have routinely received conventional oxygen therapy (COT) following extubation. High- flow nasal cannula (HCNC) therapy has emerged as an innovative respiratory support system. By synthesizing all currently available high-quality randomized controlled trials (RCTs), this study aimed to rigorously evaluate the efficacy and safety of HFNC compared to COT, focusing primarily on determining the need for escalation of respiratory support. METHODOLOGY: A thorough electronic search was carried out in the PubMed, Embase, and Scopus databases from their inception to May 2026. Only RCTs were considered for analysis. A random-effects model was applied to compute pooled estimates and 95% confidence intervals (CIs). RESULTS: A total of 11 RCTs, comprising 2473 patients, were included in this systematic review and meta-analysis. HFNC had a statistically significant effect on reducing the requirement for escalation of respiratory support (risk ratio [RR] = 0.71; 95% CI, 0.55-0.93; p = 0.01). HFNC had a statistically significant effect on improving the arterial partial pressure of oxygen, as well as forced expiratory volume in 1 second, while also increasing delirium complications (RR = 3.63; 95% CI, 1.80-7.30; p = 0.0003). There were no statistically significant differences between the 2 approaches in the other secondary clinical and resource utilization outcomes, including intubation, overall mortality, hospital length of stay, intensive care unit length of stay, and postoperative atrial fibrillation. CONCLUSION: In adult patients recovering from cardiac surgery, HFNC therapy improves oxygenation and significantly curtails the need to escalate respiratory support compared to COT. However, these physiologic and intermediate clinical benefits do not translate into reductions in mortality, reintubation rate, or hospital length of stay and may come at the cost of increased postoperative delirium.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Efficacy and Safety of Etomidate Versus Ketamine for Endotracheal Intubation in Critically Ill Patients: A Systematic Review and Meta-Analysis.
Clinical takeaway The pooled trials did not demonstrate a mortality difference between induction agents. Uncertainty around cardiac arrest and vasopressor estimates precludes interpreting these findings as equivalence.
Summary & abstract
Study summary
This systematic review pooled seven randomized trials involving 5234 critically ill adults undergoing emergency intubation with etomidate or ketamine. Etomidate versus ketamine showed no statistically significant difference in 28-day mortality (RR 1.01; 95% CI 0.93-1.10) or cardiac arrest (RR 0.91; 95% CI 0.62-1.34). Failed intubation (RR 1.09; 95% CI 0.68-1.76) and vasopressor requirement (RR 1.27; 95% CI 0.94-1.72) also did not differ significantly. Sensitivity analyses suggested possible haemodynamic differences, with relative cardiovascular stability for etomidate in some analyses, but these findings require cautious interpretation.
Study limitation: The abstract provides no cardiac ICU-specific subgroup results, limiting assessment of applicability to patients with cardiovascular critical illness.
Published abstract
Rapid sequence intubation (RSI) is a commonly used technique for critically ill patients requiring emergency intubation, and the choice of induction agent is crucial for minimizing peri-intubation morbidity and maintaining hemodynamic stability. The most commonly used induction agents are etomidate and ketamine, although controversy remains about their effectiveness and safety. Therefore, this systematic review and meta-analysis compared the efficacy and safety of etomidate versus ketamine for endotracheal intubation in critically ill patients. Randomized controlled trials (RCTs) published between 2000 and May 2026 were systematically searched in PubMed, The Cochrane Library, and ScienceDirect. The included studies compared etomidate with ketamine for emergency endotracheal intubation in critically ill adults. We analyzed data with RevMan 5.4 and Mantel-Haenszel random-effects models and calculated risk ratios (RRs) with 95% confidence intervals (CIs). Seven RCTs involving 5234 patients were included in the final analysis. No significant difference was observed between etomidate and ketamine regarding 28-day mortality (RR 1.01; 95% confidence interval (CI) 0.93-1.10; p=0.84), cardiac arrest (RR 0.91; 95% CI 0.62-1.34; p = 0.64), failed intubation (RR 1.09; 95% CI 0.68-1.76; p=0.71), or vasopressor requirement (RR 1.27; 95% CI 0.94-1.72; p=0.13). Sensitivity analyses suggested possible hemodynamic differences between the two agents, which should be interpreted cautiously, and etomidate was relatively cardiovascularly stable in some analyses. Overall, etomidate and ketamine showed similar efficacy and safety for endotracheal intubation in critically ill patients. No statistically significant differences were observed between the two agents in mortality, cardiac arrest, failed intubation, or vasopressor use. Thus, clinicians should choose the induction agent on a case-by-case basis, based on patient, hemodynamic, and clinician-specific factors. Randomized trials in selected critically ill patient populations should be conducted on a larger scale.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.