Comparison of high-flow nasal oxygen therapy with conventional oxygen therapy and noninvasive ventilation in adult patients with acute hypoxemic respiratory failure: A meta-analysis and systematic review

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

Download Full-text

Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials

Canadian Medical Association Journal ◽

10.1503/cmaj.160570 ◽

2017 ◽

Vol 189 (7) ◽

pp. E260-E267 ◽

Cited By ~ 45

Author(s):

Xiaofeng Ou ◽

Yusi Hua ◽

Jin Liu ◽

Cansheng Gong ◽

Wenling Zhao

Keyword(s):

Respiratory Failure ◽

Randomized Controlled Trials ◽

Oxygen Therapy ◽

Meta Analysis ◽

High Flow ◽

Controlled Trials ◽

High Flow Nasal Cannula ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Randomized Controlled

Download Full-text

Does high-flow nasal cannula oxygen improve outcome in acute hypoxemic respiratory failure? A systematic review and meta-analysis

Respiratory Medicine ◽

10.1016/j.rmed.2017.08.005 ◽

2017 ◽

Vol 131 ◽

pp. 58-64 ◽

Cited By ~ 11

Author(s):

Si-ming Lin ◽

Kai-xiong Liu ◽

Zhi-hong Lin ◽

Pei-hong Lin

Keyword(s):

Systematic Review ◽

Respiratory Failure ◽

Meta Analysis ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Improve Outcome

Download Full-text

Effect of High-Flow Nasal Cannula Oxygen Therapy Versus Conventional Oxygen Therapy and Noninvasive Ventilation on Reintubation Rate in Adult Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Journal of Intensive Care Medicine ◽

10.1177/0885066617705118 ◽

2017 ◽

Vol 33 (11) ◽

pp. 609-623 ◽

Cited By ~ 16

Author(s):

Hua-Wei Huang ◽

Xiu-Mei Sun ◽

Zhong-Hua Shi ◽

Guang-Qiang Chen ◽

Lu Chen ◽

...

Keyword(s):

Systematic Review ◽

Noninvasive Ventilation ◽

Oxygen Therapy ◽

Primary Outcome ◽

Meta Analysis ◽

High Flow ◽

Adult Patients ◽

Controlled Trials ◽

High Flow Nasal Cannula ◽

Randomized Controlled

Purpose: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of high-flow nasal cannula (HFNC) on reintubation in adult patients. Procedures: Ovid Medline, Embase, and Cochrane Database of Systematic Reviews were searched up to November 1, 2016, for RCTs comparing HFNC versus conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in adult patients after extubation. The primary outcome was reintubation rate, and the secondary outcomes included complications, tolerance and comfort, time to reintubation, length of stay, and mortality. Dichotomous outcomes were presented as risk ratio (RR) with 95% confidence intervals (CIs) and continuous outcomes as weighted mean difference and 95% CIs. The random effects model was used for data pooling. Findings: Seven RCTs involving 2781 patients were included in the analysis. The HFNC had a similar reintubation rate compared to either COT (RR, 0.58; 95% CI, 0.21-1.60; P = .29; 5 RCTs, n = 1347) or NIV (RR, 1.11; 95% CI, 0.88-1.40; P = .37; 2 RCTs, n = 1434). In subgroup of critically ill patients, the HFNC group had a significantly lower reintubation rate compared to the COT group (RR, 0.35; 95% CI, 0.19-0.64; P = .0007; 2 RCTs, n = 632; interaction P = .07 compared to postoperative subgroup). Qualitative analysis suggested that HFNC might be associated with less complications and improved patient’s tolerance and comfort. The HFNC might not delay reintubation. Trial sequential analysis on the primary outcome showed that required information size was not reached. Conclusion: The evidence suggests that COT may still be the first-line therapy in postoperative patients without acute respiratory failure. However, in critically ill patients, HFNC may be a potential alternative respiratory support to COT and NIV, with the latter often associating with patient intolerance and requiring a monitored setting. Because required information size was not reached, further high-quality studies are required to confirm these results.

Download Full-text