Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

Abstract

Background: High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. Objectives: We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19. Methods: We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO2/FiO2, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)]. Results: In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51–0.84, p = 0.0008, I2 = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63–2.32, p = 0.57, I2 = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51–1.17, p = 0.23, I2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO2/FiO2, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups. Conclusion: Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or CPAP group. Future large sample RCTs are necessary to prove our findings. Registration: This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).

The Use of High-Flow Nasal Cannula and Non-Invasive Mechanical Ventilation in the Management of COVID-19 Patients: A Prospective Study

“…However, the study findings may not be generalizable to moderate to severe COVID-19 patients, as the mean FiO 2 used was 38%, suggestive of milder COVID illness. Recently, a systematic review and meta-analysis by Yun Peng et al [19], including 3 RCTs and 20 observational studies comparing the use of NIV versus HFNC in both ICU and ward patients, demonstrated no difference in mortality rate between helmet NIV and HFNC, confirming the findings of our study.…”

Efficiency of continuous positive airway pressure and high-flow nasal oxygen therapy in critically ill patients with COVID-19

“…Additionally, the meta-analysis showed no statistically significant differences in the PaO 2 /FiO 2 ratio, total number of hospital or ICU days, and intubation rate between the HFNO and NIV groups. 36 A literature review of patients with COVID-19 revealed that HFNO can decrease the need for intubation, the severity of complications related to mechanical ventilation, and the duration of ICU stay. 37 A clinical study of 1400 patients showed that the 60-day risk of mortality was similar between patients who had received invasive mechanical ventilation since admission and patients those intubated after NIV.…”

High flow nasal oxygen and awake prone positioning – Two allies against COVID-19: A systematic review

“…Accordingly, our search revealed that HFNO/ APP strategy can avoid or delay intubation in patients at risk, but intubation remains a clinicians’ decision based on individual patients’ factors (i.e., tiring, work of breathing, consolidation burden). The use of HFNO alone demonstrated lower intubation rates both in patients with and without COVID-19 AHRF ( Agarwal et al, 2020 , Demoule et al, 2020 , Ospina-Tascón et al, 2021 , Peng et al, 2022 , Perkins et al, 2022 ) . Additionally, HFNO facilitates the management of FiO 2 reliably while concurrently modifying the conditions of the gas supplied such as temperature and humidity ( Raoof et al, 2020 , Suffredini and Allison, 2021 ).…”