High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis

Abstract

BackgroundHigh-flow nasal cannula oxygen (HFNC) is a relatively new therapy used in adults with respiratory failure. Whether it is superior to conventional oxygen therapy (COT) or to noninvasive mechanical ventilation (NIV) remains unclear. The aim of the present study was to investigate whether HFNC was superior to either COT or NIV in adult acute respiratory failure patients.MethodsA review of the literature was conducted from the electronic databases from inception up to 20 October 2016. Only randomized clinical trials comparing HFNC with COT or HFNC with NIV were included. The intubation rate was the primary outcome; secondary outcomes included the mechanical ventilation rate, the rate of escalation of respiratory support and mortality.ResultsEleven studies that enrolled 3459 patients (HFNC, n = 1681) were included. There were eight studies comparing HFNC with COT, two comparing HFNC with NIV, and one comparing all three. HFNC was associated with a significant reduction in intubation rate (OR 0.52, 95% CI 0.34 to 0.79, P = 0.002), mechanical ventilation rate (OR 0.56, 95% CI 0.33 to 0.97, P = 0.04) and the rate of escalation of respiratory support (OR 0.45, 95% CI 0.31 to 0.67, P < 0.0001) when compared to COT. There was no difference in mortality between HFNC and COT utilization (OR 1.01, 95% CI 0.67 to 1.53, P = 0.96). When HFNC was compared to NIV, there was no difference in the intubation rate (OR 0.96; 95% CI 0.66 to 1.39, P = 0.84), the rate of escalation of respiratory support (OR 1.00, 95% CI 0.77 to 1.28, P = 0.97) or mortality (OR 0.85, 95% CI 0.43 to 1.68, P = 0.65).ConclusionsCompared to COT, HFNC reduced the rate of intubation, mechanical ventilation and the escalation of respiratory support. When compared to NIV, HFNC showed no better outcomes. Large-scale randomized controlled trials are necessary to prove our findings.Trial registrationPROSPERO International prospective register of systematic reviews on May 25, 2016 registration no. CRD42016039581.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1760-8) contains supplementary material, which is available to authorized users.

The experience of high flow nasal cannula in hospitalized patients with 2019 novel coronavirus–infected pneumonia in Chongqing, China

“…Most of them had no experience on how to use HFNC or NIV. The current knowledge shows that 1) the HFNC is non-inferior to NIV on intubation rate in critically ill patients [14]; 2) the use of HFNC is more comfortable than NIV and the skin breakdown is less likely to occur [15,16]; and 3) the manipulation of HFNC is much easier than NIV. Therefore, the clinical staffs were more likely to use HFNC in NCIP patients.…”

The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China

“…Most of them had no experience on how to use HFNC or NIV. The current knowledge shows that (1) the HFNC is non-inferior to NIV on intubation rate in critically ill patients [15]; (2) the use of HFNC is more comfortable than NIV and the skin breakdown is less likely to occur [16,17]; and (3) the manipulation of HFNC is much easier than NIV. Therefore, the clinical staff were more likely to use HFNC in NCIP patients.…”

Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature

“…This is the first integrative review article, and the second review paper after Farley et al's (2015) Cochrane review, which focussed on answering the question of what is the up-to-date knowledge about weaning this innovative oxygen intervention among children. Previous literature reviews on HHFNC therapy usually discussed its impact on the patient's length of stay (Mikalsen et al, 2016;Zhao et al, 2017). Specific literature reviews on weaning revealed no existing models (Farley et al, 2015); moreover, international concensus on weaning standards is yet to be achieved (Yoder et al, 2017).…”

“…To date, there is no sufficient evidence to support superiority or inferiority of HHFNC over conventional oxygen therapy (Fleeman et al, 2016;Kernick & Magarey, 2010;Mikalsen et al, 2016;Wilkinson et al, 2016;Zhao, Wang, Sun, Lyu, & An, 2017); however, in a recent systematic review, Lee et al (2016) suggested that HHFNC is recommended as an "intermediate level of oxygen therapy" between usual care and non-invasive ventilation due to its "superior comfort and patient tolerance." Furthermore, the reported reduction of length of stay in some studies (Blackwood, 2008;Chlan, 2013) contributes to the over-all positive perception of clinicians which could potentially encourage wider adoption in the future.…”