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Meta-Analysis
. 2020 Apr;48(4):571-578.
doi: 10.1097/CCM.0000000000004217.

Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis

Dipayan Chaudhuri  1 , David Granton  1 , Dominic Xiang Wang  2 , Sharon Einav  3   4 , Yigal Helviz  3 , Tommaso Mauri  5   6 , Jean-Damien Ricard  7   8 , Jordi Mancebo  9 , Jean-Pierre Frat  10   11   12 , Sameer Jog  13 , Gonzalo Hernandez  14 , Salvatore M Maggiore  15 , Carol Hodgson  16 , Samir Jaber  17 , Laurent Brochard  18 , Karen E A Burns  18 , Bram Rochwerg  1   19
Affiliations
Meta-Analysis

Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis

Dipayan Chaudhuri et al. Crit Care Med. 2020 Apr.

Abstract

Objective: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.

Data sources: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).

Study selection: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.

Data extraction: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, PaO2 before and after intubation, PaCO2 after intubation, ICU length of stay, and short-term mortality.

Data synthesis: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68-1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71-1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), PaO2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or PaO2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation PaCO2, ICU length of stay, or 28-day mortality.

Conclusions: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.

Trial registration: ClinicalTrials.gov NCT02107183.

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