Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jan-Dec:16:17534666221087847.
doi: 10.1177/17534666221087847.

High-flow nasal cannula versus noninvasive ventilation in patients with COVID-19: a systematic review and meta-analysis

Yuewen He  1 , Na Liu  2 , Xuhui Zhuang  1 , Xia Wang  1 , Wuhua Ma  3
Affiliations
Meta-Analysis

High-flow nasal cannula versus noninvasive ventilation in patients with COVID-19: a systematic review and meta-analysis

Yuewen He et al. Ther Adv Respir Dis. 2022 Jan-Dec.

Abstract

Background: During the novel coronavirus disease 2019 (COVID-19) pandemic raging around the world, the effectiveness of respiratory support treatment has dominated people's field of vision. This study aimed to compare the effectiveness and value of high-flow nasal cannula (HFNC) with noninvasive ventilation (NIV) for COVID-19 patients.

Methods: A comprehensive systematic review via PubMed, Web of Science, Cochrane, Scopus, WHO database, China Biology Medicine Disc (SINOMED), and China National Knowledge Infrastructure (CNKI) databases was conducted, followed by meta-analysis. RevMan 5.4 was used to analyze the results and risk of bias. The primary outcome is the number of deaths at day 28. The secondary outcomes are the occurrence of invasive mechanical ventilation (IMV), the number of deaths (no time-limited), length of intensive care unit (ICU) and hospital stay, ventilator-free days, and oxygenation index [partial pressure of arterial oxygen (PaO2)/fraction of inhaled oxygen (FiO2)] at 24 h.

Results: In total, nine studies [one randomized controlled trial (RCT), seven retrospective studies, and one prospective study] totaling 1582 patients were enrolled in the meta-analysis. The results showed that the incidence of IMV, number of deaths (no time-limited), and length of ICU stay were not statistically significant in the HFNC group compared with the NIV group (ps = 0.71, 0.31, and 0.33, respectively). Whereas the HFNC group performed significant advantages in terms of the number of deaths at day 28, length of hospital stay and oxygenation index (p < 0.05). Only in the ventilator-free days did NIV show advantages over the HFNC group (p < 0.0001).

Conclusion: For COVID-19 patients, the use of HFNC therapy is associated with the reduction of the number of deaths at day 28 and length of hospital stay, and can significantly improve oxygenation index (PaO2/FiO2) at 24 h. However, there was no favorable between the HFNC and NIV groups in the occurrence of IMV. NIV group was superior only in terms of ventilator-free days.

Keywords: coronavirus disease 2019; high-flow nasal cannula; noninvasive ventilation.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of search strategy and included studies.
Figure 2.
Figure 2.
Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies.
Figure 3.
Figure 3.
(a) The number of deaths at day 28 and (b) the number of deaths (no time-limited).
Figure 4.
Figure 4.
The occurrence of IMV.
Figure 5.
Figure 5.
(a) The length of ICU stay and (b) the length of hospital stay.
Figure 6.
Figure 6.
The ventilator-free days.
Figure 7.
Figure 7.
The oxygenation index (PaO2/FiO2) at 24 h.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization. COVID-19 weekly epidemiological update, edition 62. Geneva: World Health Organization, 19 October 2021.
    1. Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA Netw Open 2021; 4: e2035057. - PMC - PubMed
    1. Gao Z, Xu Y, Sun C, et al. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect 2021; 54: 12–16. - PMC - PubMed
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061–1069. - PMC - PubMed
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. - PMC - PubMed

MeSH terms