High-Flow Nasal Cannula Versus Noninvasive Ventilation in Patients With COVID-19

Abstract

BACKGROUND: High-flow nasal cannula (HFNC) oxygen and noninvasive ventilation (NIV) have been widely used in patients with acute hypoxic respiratory failure (AHRF) due to COVID-19. However, the impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. Therefore, we performed this meta-analysis to evaluate the effect of HFNC versus NIV in COVID-19-related AHRF. METHODS: Several electronic databases were searched through February 10, 2022, for eligible studies comparing HFNC and NIV in COVID-19-related AHRF. Our primary outcome was intubation. The secondary outcomes were mortality, hospital length of stay (LOS), and P aO 2 /F IO 2 changes. Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% CI were obtained using a random-effect model. Prediction intervals were calculated to indicate the variance in outcomes that would be expected if new studies were conducted in the future. RESULTS: Nineteen studies involving 3,606 subjects (1,880 received HFNC and 1,726 received NIV) were included. There were no differences in intubation (RR 1.01 [95% CI 0.85-1.20], P 5 .89) or LOS (MD 0.38 d [95% CI 20.61 to 1.37], P 5 .45) between groups, with consistent results on the subgroup of randomized controlled trials (RCTs). Mortality was lower in NIV (RR 0.81 [95% CI 0.66-0.98], P 5 .03). However, the prediction interval was 0.41-1.59, and subgroup analysis of RCTs showed no difference in mortality between groups. There was a greater improvement in P aO 2 /F IO 2 with NIV ], P 5 .01). CONCLUSIONS: Our study showed that despite the greater improvement in P aO 2 /F IO 2 with NIV, intubation rates and LOS were similar between HFNC and NIV. Although mortality was lower with HFNC than NIV, the prediction interval included the null value, and there was no difference in mortality between HFNC and NIV on a subgroup of RCTs. Future large-scale RCTs are necessary to support our findings.

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 – 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.…”

An Analysis of the Effect of Noninvasive Positive Pressure Ventilation on Patients with Respiratory Failure Complicated by Diabetes Mellitus

“…It has been stated that noninvasive positive pressure ventilation should be used as early as possible to dilate the pulmonary blood vessels of patients, thereby maintaining pulmonary functional residual capacity, reducing intrapulmonary shunts, improving pulmonary ventilation, decreasing respiratory failure symptoms, reducing inflammation caused by hypoxia, and accelerating recovery [18]. The reason may be that noninvasive positive pressure ventilation is a form of artificial ventilation assisted by a nasal mask that connects the ventilator to the patient, with the ventilator providing positive pressure support [19]. When this positive pressure is reduced or withdrawn, the whole chest and lungs rebound, and gas is exhaled, which allows ventilation equivalent to physiological breathing and negative pressure ventilation.…”

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

“…A meta-analysis comparing HFNC and NIV in patients with COVID-19 pneumonia showed no significant differences between the two groups in terms of intubation rate, mortality and length of hospital stay. 47 …”