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Meta-Analysis
. 2022 Jan-Dec:16:17534666221091931.
doi: 10.1177/17534666221091931.

Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis

Dong-Yang Xu  1 , Bing Dai  2 , Wei Tan  3 , Hong-Wen Zhao  1 , Wei Wang  1 , Jian Kang  1
Affiliations
Meta-Analysis

Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis

Dong-Yang Xu et al. Ther Adv Respir Dis. 2022 Jan-Dec.

Abstract

Background: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients with severe cases have received oxygen therapy through a high-flow nasal cannula (HFNC).

Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk factors for HFNC failure.

Methods: We searched PubMed, Embase, and the Cochrane Central Register of randomized controlled trials (RCTs) and observational studies of HFNC in patients with COVID-19 published in English from January 1st, 2020 to August 15th, 2021. The primary aim was to assess intubation, mortality, and failure rates in COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC success and failure groups and to describe the risk factors for HFNC failure.

Results: A total of 25 studies fulfilled selection criteria and included 2851 patients. The intubation, mortality, and failure rates were 0.44 (95% confidence interval (CI): 0.38-0.51, I2 = 84%), 0.23 (95% CI: 0.19-0.29, I2 = 88%), and 0.47 (95% CI: 0.42-0.51, I2 = 56%), respectively. Compared to the success group, age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer, lactate, heart rate, and respiratory rate were higher and PaO2, PaO2/FiO2, ROX index (the ratio of SpO2/FiO2 to respiratory rate), ROX index after the initiation of HFNC, and duration of HFNC were lower in the failure group (all Ps < 0.05). There were also more smokers and more comorbidities in the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that older age (OR: 1.04, 95% CI: 1.01-1.07, P = 0.02, I2 = 88%), a higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01-1.12, P = 0.02, I2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15-1.76, P < 0.01, I2 = 0%), and a lower ROX index(OR: 0.61, 95% CI: 0.39-0.95, P = 0.03, I2 = 93%) after the initiation of HFNC were all significant risk factors for HFNC failure.

Conclusions: HFNC is an effective way of providing respiratory support in the treatment of COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a lower ROX index after the initiation of HFNC are associated with an increased risk of HFNC failure.

Keywords: COVID-19; ROX index; age; high-flow nasal cannula; risk factor.

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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.
Selection of studies for the meta-analysis (PRISMA). PRISMA: preferred reporting items for systematic reviews and meta-analyses.
Figure 2.
Figure 2.
Funnel plots of the proportion versus the standard error of intubation (a), mortality (b), and failure rates(c). Circles indicate studies included in the meta-analysis.
Figure 3.
Figure 3.
Intubation (a), mortality (b), and failure (c) rates for COVID-19 patients who received HFNC. COVID-19: coronavirus disease 2019; HFNC: high-flow nasal cannula.
Figure 4.
Figure 4.
Forest plots of significant risk and protective factors for HFNC failure: age (a), white blood cell count (b), heart rate (c), ROX index (d). HFNC, high-flow nasal cannula; ROX index, the ratio of SpO2/FiO2 to respiratory rate.
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