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
. 2023 Mar 30;13(3):e067879.
doi: 10.1136/bmjopen-2022-067879.

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review

Yang Li  1 , Cong Li  1 , Wei Chang  1 , Ling Liu  2
Affiliations
Meta-Analysis

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review

Yang Li et al. BMJ Open. .

Abstract

Objective: This study aimed to investigate the effect of high-flow nasal cannula therapy (HFNC) versus conventional oxygen therapy (COT) on intubation rate, 28-day intensive care unit (ICU) mortality, 28-day ventilator-free days (VFDs) and ICU length of stay (ICU LOS) in adult patients with acute respiratory failure (ARF) associated with COVID-19.

Design: Systematic review and meta-analysis.

Data sources: PubMed, Web of Science, Cochrane Library and Embase up to June 2022.

Eligibility criteria for selecting studies: Only randomised controlled trials or cohort studies comparing HFNC with COT in patients with COVID-19 were included up to June 2022. Studies conducted on children or pregnant women, and those not published in English were excluded.

Data extraction and synthesis: Two reviewers independently screened the titles, abstracts and full texts. Relevant information was extracted and curated in the tables. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to assess the quality of randomised controlled trials or cohort studies. Meta-analysis was conducted using RevMan V.5.4 computer software using a random effects model with a 95% CI. Heterogeneity was assessed using Cochran's Q test (χ2) and Higgins I2 statistics, with subgroup analyses to account for sources of heterogeneity.

Results: Nine studies involving 3370 (1480 received HFNC) were included. HFNC reduced the intubation rate compared with COT (OR 0.44, 95% CI 0.28 to 0.71, p=0.0007), decreased 28-day ICU mortality (OR 0.54, 95% CI 0.30 to 0.97, p=0.04) and improved 28-day VFDs (mean difference (MD) 2.58, 95% CI 1.70 to 3.45, p<0.00001). However, HFNC had no effect on ICU LOS versus COT (MD 0.52, 95% CI -1.01 to 2.06, p=0.50).

Conclusions: Our study indicates that HFNC may reduce intubation rate and 28-day ICU mortality, and improve 28-day VFDs in patients with ARF due to COVID-19 compared with COT. Large-scale randomised controlled trials are necessary to validate our findings.

Prospero registration number: CRD42022345713.

Keywords: COVID-19; adult intensive & critical care; respiratory infections.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of search strategy and included studies. COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; RCT, randomised controlled trial; WOS, Web of Science.
Figure 2
Figure 2
Forest plot for intubation rate. COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; M-H, Mantel-Haenszel.
Figure 3
Figure 3
Forest plot for mortality. COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; M-H, Mantel-Haenszel.
Figure 4
Figure 4
Forest plot for VFDs. COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; VFDs, ventilator-free days.
Figure 5
Figure 5
Forest plot for ICU LOS. COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; ICU, intensive care unit; LOS, length of stay.
See this image and copyright information in PMC

References

    1. World Health Organization . COVID-19 weekly epidemiological update edition 98. 2022. Available: www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-1...
    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. 10.1016/S0140-6736(20)30183-5 - DOI - 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;323:1061–9. 10.1001/jama.2020.1585 - DOI - PMC - PubMed
    1. Curley GF, Laffey JG, Zhang H, et al. Biotrauma and ventilator-induced lung injury: clinical implications. Chest 2016;150:1109–17. 10.1016/j.chest.2016.07.019 - DOI - PubMed
    1. Oliveira J, Zagalo C, Cavaco-Silva P. Prevention of ventilator-associated pneumonia. Rev Port Pneumol 2014;20:152–61. 10.1016/j.rppneu.2014.01.002 - DOI - PubMed

Publication types