The Use of High Flow Nasal Oxygen and Its Effects on Reintubation When Compared to Non-Invasive Ventilation a Systematic Review and Meta-Analysis

Abstract

Rationale: Post-extubation acute respiratory failure (ARF), post-extubation pneumonia (PEP) and intensive care unit (ICU) mortality are some the most serious complications in the ICU setting. Several methods are currently being investigated in preventing these serious complications. This literature review looks at the role of high flow nasal oxygen (HFNO) compared to non-invasive ventilation (NIV) and the efficacy of HFNO in preventing reintubation. Methods: We conducted a thorough search of the literature to conduct a systematic review and meta-analysis of the available studies that investigated the efficacy of HFNO compared to NIV in preventing reintubation after recent extubation. This comprehensive search was performed using PubMed, Embase, and Cochrane Central Register of Controlled Trials for data on the subject matter of study from inception to December 18, 2020. We considered randomized controlled trials, cohort studies and case-control studies. From each study, we collected the number of patients who underwent treatment with either HFNO or NIV after extubation. The primary outcome was the occurrence of ARF requiring reintubation. Secondary outcomes were the occurrence of VAP and ICU mortality. The random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CIs). A p-value <0.05 was considered statistically significant. Heterogeneity was assessed using Higgins I 2 index. Results: Five randomized controlled trials involving 1153 patients were including in this meta-analysis. The rate of reintubation was not found to be significantly lower in patients receiving HFNO when compared to those receiving NIV after extubation (17.2% vs. 16.2%, RR 1.09, 95% CI 0.84-1.41, p= 0.52, I 2 = 0%). The rates of ICU mortality after extubation were not found to be significantly lower in patients receiving HFNO when compared to those receiving NIV (7.3% vs. 7.40%, RR 0.99, 95% CI 0.65-1.49, p= 0.95, I 2 = 0%). Two studies reported the rate of PEP, which was not found to be significantly lower in patients receiving HFNO when compared to those receiving NIV after extubation (6.82% vs. 7.55%, RR 0.89, 95% CI 0.56-1.44, p= 0.64, I 2 = 0%). Conclusion: Our meta-analysis demonstrates that the use of HFNO after extubation, when compared to NIV, does not significantly reduce the rate of reintubation, ICU mortality, or PEP. HFNO may however produce similar results to NIV when used post-extubation in regards to the outcomes of study in this meta-analysis, but further data from future studies is needed to support this claim.