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Meta-Analysis
. 2018 Oct 16;19(1):202.
doi: 10.1186/s12931-018-0908-7.

High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis

Zhiheng Xu  1   2 , Yimin Li  1   2 , Jianmeng Zhou  1 , Xi Li  1   2 , Yongbo Huang  1   2 , Xiaoqing Liu  1 , Karen E A Burns  3   4   5 , Nanshan Zhong  1 , Haibo Zhang  6   7   8   9   10
Affiliations
Meta-Analysis

High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis

Zhiheng Xu et al. Respir Res. .

Abstract

Background: High-flow nasal cannula (HFNC) can be used as an initial support strategy for patients with acute respiratory failure (ARF) and after extubation. However, no clear evidence exists to support or oppose HFNC use in clinical practice. We summarized the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on important outcomes including treatment failure and intubation/reintubation rates in adult patients with ARF and after extubation.

Methods: We searched 4 electronic databases (Pubmed, EMBASE, Scopus, and Web of Science) to identify randomized controlled trials (RCTs) comparing the effects of HFNC with either COT or NIV on rates of 1) treatment failure and 2) intubation/reintubation in adult critically ill patients.

Results: We identified 18 RCTs (n = 4251 patients) in pooled analyses. As a primary mode of support, HFNC treatment reduced the risk of treatment failure [Odds Ratio (OR) 0.65; 95% confidence interval (CI) 0.43-0.98; p = 0.04; I2 = 32%] but had no effect on preventing intubation (OR, 0.74; 95%CI 0.45-1.21; p = 0.23; I2 = 0%) compared to COT. When used after extubation, HFNC (vs. COT) treatment significantly decreased reintubation rate (OR 0.46; 95%CI 0.33-0.63; p < 0.00001; I2 = 30%) and extubation failure (OR 0.43; 95%CI 0.25-0.73; p = 0.002; I2 = 66%). Compared to NIV, HFNC significantly reduced intubation rate (OR 0.57; 95%CI 0.36-0.92; p = 0.02; I2 = 0%) when used as initial support, but did no favorably impact clinical outcomes post extubation in few trials.

Conclusions: HFNC was superior to COT in reducing treatment failure when used as a primary support strategy and in reducing rates of extubation failure and reintubation when used after extubation. In few trials, HFNC reduced intubation rate compared to NIV when used as initial support but demonstrated no beneficial effects after extubation.

Keywords: Conventional oxygen therapy; Extubation; Noninvasive ventilation.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Search strategy of meta-analysis on selecting patients for inclusion
Fig. 2
Fig. 2
Risk of bias diagram for each study. Green represents low risk of bias, yellow represents unclear risk of bias, and red represents high risk of bias
Fig. 3
Fig. 3
Treatment failure of HFNC versus COT as an initial support in ARF. Pooled estimates of treatment failure of HFNC compared with COT in patients used as an initial support
Fig. 4
Fig. 4
Treatment failure of HFNC versus COT after extubation. Pooled estimates of treatment failure of HFNC compared with COT in extubated patients from IMV
Fig. 5
Fig. 5
Reintubation rate of HFNC versus COT after extubation. Pooled estimates of risk of reintubation in patients after extubation supported on HFNC compared with COT
See this image and copyright information in PMC

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