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

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.

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

“…In our meta-analysis, we found that there were no differences in intubation rate, PaO 2 /FiO 2 , ICU LOS, hospital LOS, or VFD between the NIV and HFNC group, but mortality was significantly higher among COVID-19 patients in the NIV group, consistent with three recent meta-analyses. [36][37][38] Whether this was because of the delayed intubation and increased mortality in the NIV group is still unclear. In general, the role of NIV is indeed controversial.…”

High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials

“…Of the remaining 34 studies, 26 studies were excluded after full review, leaving eight studies. Among the studies excluded after full-text review, 19 were not RCTs, 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 two were conference abstracts, 27 , 28 and five did not meet inclusion criteria. 29 , 30 , 31 , 32 , 33 The Helmet-COVID RCT, comparing helmet-NIV vs usual respiratory support did not meet inclusion criteria because it included facemask-NIV as part of usual respiratory support.…”

Comparison of the efficacy and comfort of high-flow nasal cannula with different initial flow settings in patients with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

“…What worries us the most is the invasive ventilation caused by AHRF. Acute respiratory failure progresses rapidly, often requiring mechanical ventilation in the late stages, and there is conclusive evidence of a direct relationship between invasive ventilation and the occurrence of adverse events [ 4 , 50 ]. Our NMA and ranking analysis results showed that the HFNC_High group was the best strategy for reducing intubation incidence at day 28.…”