The Impact of High-Flow Nasal Cannula on the Outcome of Immunocompromised Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis

Abstract

Background and objectives: High-flow nasal cannula (HFNC) can be used as a respiratory support strategy for patients with acute respiratory failure (ARF). However, no clear evidence exists to support or oppose HFNC use in immunocompromised patients. Thus, this meta-analysis aims to assess the effects of HFNC, compared to conventional oxygen therapy (COT) and noninvasive ventilation (NIV), on the outcomes in immunocompromised patients with ARF. The Pubmed, Embase and Cochrane databases were searched up to November 2018. Materials and Methods: Only clinical studies comparing the effect of HFNC with COT or NIV for immunocompromised patients with ARF were included. The outcome included the rate of intubation, mortality and length of stay (LOS). Results: A total of eight studies involving 1433 immunocompromised patients with ARF were enrolled. The pooled analysis showed that HFNC was significantly associated with a reduced intubation rate (risk ratio (RR), 0.83; 95% confidence interval (CI), 0.74–0.94, I2 = 0%). Among subgroup analysis, HFNC was associated with a lower intubation rate than COT (RR, 0.86; 95% CI, 0.75–0.95, I2 = 0%) and NIV (RR, 0.59; 95% CI, 0.40–0.86, I2 = 0%), respectively. However, there was no significant difference between HFNC and control groups in terms of 28-day mortality (RR, 0.78; 95% CI, 0.58–1.04, I2 = 48%), and intensive care unit (ICU) mortality (RR, 0.87; 95% CI, 0.73–1.05, I2 = 57%). The ICU and hospital LOS were similar between HFNC and control groups (ICU LOS: mean difference, 0.49 days; 95% CI, −0.25–1.23, I2 = 69%; hospital LOS: mean difference, −0.12 days; 95% CI, −1.86–1.61, I2 = 64%). Conclusions: Use of HFNC may decrease the intubation rate in immunocompromised patients with ARF compared with the control group, including COT and NIV. However, HFNC could not provide additional survival benefit or shorten the LOS. Further large, randomized controlled trials are needed to confirm these findings.

High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission

“…Full-text review of 38 potentially eligible studies identified 20 eligible studies. Of these, 17 were systematic reviews (SRs) 15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and three were RCTs [41][42][43] (Fig. 1).…”

High flow nasal cannula for adult acute hypoxemic respiratory failure in the ED setting

“…A 2017 post hoc analysis found no difference in intubation rate or 28 day mortality between HFNC and conventional oxygen therapies [ 72 ]. Finally, meta-analyses of these studies comparing HFNC and conventional oxygen therapy or NIPPV demonstrate reduced intubation (RR 0.83–0.89), but no difference in mortality or length of stay [ [73] , [74] , [75] ]. HFNC is recommended over conventional oxygen therapies in this patient population and can reduce need for intubation.…”

High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future

“…Successively, other studies have outlined the usefulness of HFNC in managing ARF in immuodepressed patients. 59,60 One recent meta-analysis by Cheng et al showed the superiority of HFNC versus COT in reducing the intubation rate, without benefit on survival. 60 Another meta-analysis confirmed the superiority of HFNC versus NIV in reducing the intubation rate, again without effect on mortality in the ICU.…”

“…59,60 One recent meta-analysis by Cheng et al showed the superiority of HFNC versus COT in reducing the intubation rate, without benefit on survival. 60 Another meta-analysis confirmed the superiority of HFNC versus NIV in reducing the intubation rate, again without effect on mortality in the ICU. 59 Other studies failed to show advantages of HFNC over standard treatment.…”