High-flow nasal cannula oxygen therapy versus noninvasive ventilation versus in immunocompromised patients with acute respiratory failure

Background and objectives: High-flow nasal cannula (HFNC) can be used as a respiratory support strategy for patients with acute respiratory failure (ARF). However, no clear evidence exists to support or oppose HFNC use in immunocompromised patients. Thus, this meta-analysis aims to assess the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on the outcomes in immunocompromised patients with ARF. The Pubmed, Embase and Cochrane databases were searched up to November 2018. Materials and Methods: Only clinical studies comparing the effect of HFNC with COT or NIV for immunocompromised patients with ARF were included. The outcome included the rate of intubation, mortality and length of stay (LOS). Results: A total of eight studies involving 1433 immunocompromised patients with ARF were enrolled. The pooled analysis showed that HFNC was significantly associated with a reduced intubation rate (risk ratio (RR), 0.83; 95% confidence interval (CI), 0.74–0.94, I2 = 0%). Among subgroup analysis, HFNC was associated with a lower intubation rate than COT (RR, 0.86; 95% CI, 0.75–0.95, I2 = 0%) and NIV (RR, 0.59; 95% CI, 0.40–0.86, I2 = 0%), respectively. However, there was no significant difference between HFNC and control groups in terms of 28-day mortality (RR, 0.78; 95% CI, 0.58–1.04, I2 = 48%), and intensive care unit (ICU) mortality (RR, 0.87; 95% CI, 0.73–1.05, I2 = 57%). The ICU and hospital LOS were similar between HFNC and control groups (ICU LOS: mean difference, 0.49 days; 95% CI, −0.25–1.23, I2 = 69%; hospital LOS: mean difference, −0.12 days; 95% CI, −1.86–1.61, I2 = 64%). Conclusions: Use of HFNC may decrease the intubation rate in immunocompromised patients with ARF compared with the control group, including COT and NIV. However, HFNC could not provide additional survival benefit or shorten the LOS. Further large, randomized controlled trials are needed to confirm these findings.

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Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

Acta Medica Philippina ◽

10.47895/amp.v54i0.1870 ◽

2020 ◽

Vol 54 ◽

Author(s):

Cary Amiel G. Villanueva ◽

Marie Gene D. Cruz ◽

Lia M. Palileo-Villanueva

Keyword(s):

Respiratory Failure ◽

Noninvasive Ventilation ◽

Observational Studies ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

High Flow Nasal Cannula ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure

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.

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The Effect of High-Flow Nasal Cannula Oxygen Therapy on Mortality and Intubation Rate in Acute Respiratory Failure

Critical Care Medicine ◽

10.1097/ccm.0000000000002091 ◽

2017 ◽

Vol 45 (4) ◽

pp. e449-e456 ◽

Cited By ~ 37

Author(s):

Thalia Monro-Somerville ◽

Malcolm Sim ◽

James Ruddy ◽

Mark Vilas ◽

Michael A. Gillies

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Intubation Rate ◽

High Flow Nasal Cannula

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How to treat patients with acute respiratory failure? Conventional oxygen therapy versus high-flow nasal cannula in the emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919886245 ◽

2019 ◽

pp. 102490791988624

Author(s):

Mustafa Gedikloglu ◽

Muge Gulen ◽

Salim Satar ◽

Yahya Kemal Icen ◽

Akkan Avci ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Oxygen Therapy ◽

Vital Signs ◽

High Flow ◽

Nasal Cannula ◽

Blood Gas ◽

High Flow Nasal Cannula ◽

Arterial Blood Gas ◽

Arterial Blood

Objective: To investigate whether high-flow nasal cannula oxygen therapy could reduce the rate of endotracheal intubation and improve arterial blood gas values, vital signs, and clinical outcomes of patients with hypoxemic acute respiratory failure as compared with conventional oxygen therapy alone. Methods: This retrospective, observational study was performed in the 15-month study period and included adult patients with tachypnea and hypoxemia, whose vital signs and arterial blood gas were monitored. The high-flow nasal cannula oxygen group consisted of patients admitted to the emergency department with acute respiratory failure when high-flow nasal cannula oxygen treatment was available in the hospital, while the conventional oxygen therapy group consisted of patients who have presented to the emergency department with acute respiratory failure in the absence of high-flow nasal cannula oxygen device in the hospital. The primary outcome of the study was improvement in vital signs and arterial blood gas values within first and fourth hours of the treatment. The second outcome was the need for intubation in the emergency department, length of hospital stay, and hospital mortality. Results: The decrease in the pulse and respiratory rate of high-flow nasal cannula oxygen–treated group was significantly greater than the conventional oxygen therapy group on the first and fourth hours of treatment (p < 0.001). PaO2 values were significantly higher in the high-flow nasal cannula oxygen group at the first and fourth hours of treatment (p ⩽ 0.001). Likewise, mean SaO2 levels of patients receiving high-flow nasal cannula oxygen treatment was significantly higher than those of patients in the conventional oxygen therapy group (p = 0.006 at 1 h and p < 0.001 at 4 h). In the hypercapnic patients, the decrease in PaCO2 and increase in pH and PaO2 values were significantly greater in high-flow nasal cannula oxygen group (p < 0.001). The difference between the groups regarding the need for invasive mechanical ventilation was not statistically significant (p = 0.179). Conclusion: High-flow nasal cannula oxygen treatment has been associated with favorable effects in vital signs and arterial blood gas values in patients with acute respiratory failure. High-flow nasal cannula oxygen might be considered as the first-line therapy for patients with hypoxemic and/or hypercapnic acute respiratory failure.

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