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 Nov;17(11):1091-1102.
doi: 10.1111/crj.13695. Epub 2023 Sep 12.

High flow nasal cannula versus noninvasive ventilation in the treatment of acute hypercapnic respiratory failure: A systematic review and meta-analysis

Aisling C Fahey  1 , Martina O'Connell  1   2   3 , Nicola Cornally  1 , Mohamad M Saab  1
Affiliations
Meta-Analysis

High flow nasal cannula versus noninvasive ventilation in the treatment of acute hypercapnic respiratory failure: A systematic review and meta-analysis

Aisling C Fahey et al. Clin Respir J. 2023 Nov.

Abstract

Chronic obstructive pulmonary disease can lead to acute hypercapnic respiratory failure (AHRF), often treated using noninvasive ventilation (NIV). Emerging research suggests the potential utility of high flow nasal cannula (HFNC) for AHRF. This systematic review and meta-analysis aimed to determine the effect of HFNC versus NIV on AHRF management. A search of electronic databases (CINAHL, MEDLINE, and Academic Search Complete), web sources, and trial registries was last conducted on 9 February 2023. Quality and risk of bias assessments were conducted. Meta-analyses were used to synthesise data. Seven randomised controlled trials were included. No statistically significant differences between HFNC and NIV were found within the following outcomes of interest: (i) correction of pCO2: standardised mean difference (SMD) = -0.16, 95% confidence interval (CI) (-0.34 to 0.02), p = 0.08; (ii) correction of pH: SMD = -0.05, 95% CI (-0.25 to 0.14), p = 0.59; (iii) correction of pO2: SMD = -0.15, 95% CI (-0.40 to 0.09), p = 0.22; (iv) intubation rates: risk ratio (RR) = 0.87, 95% CI (0.41 to 1.82), p = 0.71; (v) mortality rates: RR = 0.85, 95% CI (0.47 to 1.56), p = 0.61; and (vi) treatment switch: RR = 1.30, 95% CI (0.43 to 3.94), p = 0.64. More controlled trials with large sample sizes are required to investigate the management of AHRF of various aetiologies. HFNC may be used as a final exhaustive measure for COPD-related AHRF where NIV is not tolerated, and when it is not clinically indicated to extend to endotracheal intubation.

Keywords: acidosis; blood gas analysis; hypercapnia; meta-analysis; noninvasive ventilation; oxygen saturation; respiratory; respiratory insufficiency.

PubMed Disclaimer

Conflict of interest statement

No conflict of interest has been declared by the authors.

Figures

FIGURE 1
FIGURE 1
Study identification, screening, and selection process.
FIGURE 2
FIGURE 2
Risk of bias assessment of randomised and nonrandomised controlled trials using the RoB 2 tool and ROBINS‐I tool, respectively.
FIGURE 3
FIGURE 3
Forest plots for continuous outcomes.
FIGURE 4
FIGURE 4
Forest plots for dichotomous outcomes.
See this image and copyright information in PMC

References

    1. Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J. 2003;22(47 suppl):3s‐14s. doi:10.1183/09031936.03.00038503 - DOI - PubMed
    1. Ward JPT, Ward J, Leach RM. The Respiratory System at a Glance. Vol. 4. 4th ed. Wiley; 2015. https://go.exlibris.link/stPxVkFY
    1. Davidson C, Banham S, Elliott M, et al. British Thoracic Society/Intensive Care Society Guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. BMJ Open Resp Res. 2016;3(1):e000133. doi:10.1136/bmjresp-2016-000133 - DOI - PMC - PubMed
    1. Roberts SRA, Buckingham RJ, Pursey NA, Lowe D. Acidosis, non‐invasive ventilation and mortality in hospitalised COPD exacerbations. Thorax. 2011;66(1):43‐48. doi:10.1136/thx.2010.153114 - DOI - PubMed
    1. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426. doi:10.1183/13993003.02426-2016 - DOI - PubMed

MeSH terms