High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients with acute respiratory failure: a systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundAcute respiratory failure (ARF) is a common and life-threatening medical emergency in patients admitted to the hospital. Currently, there is a lack of large-scale evidence on the use of high-flow nasal cannulas (HFNC) in patients with ARF. In this systematic review and meta-analysis, we evaluated whether there were differences between HFNC therapy and conventional oxygen therapy (COT) for treating patients with ARF.MethodsThe EMBASE, Medline, and Wanfang databases and the Cochrane Library were searched. Two investigators independently collected the data and assessed the quality of each study. Randomized controlled trials that compared HFNC therapy with COT in patients with ARF were included. RevMan 5.3 was used to conduct the meta-analysis.ResultsFour studies that involved 703 patients with ARF were included, with 371 patients in the HFNC group and 332 patients in the COT group. In the overall estimates, there were no significant differences between the HFNC and COT groups in the rates of escalation of respiratory support (RR, 0.68; 95% CI, 0.37, 1.27; z = 1.20, P = 0.23), intubation (RR, 0.74; 95% CI, 0.55, 1.00; z = 1.95, P = 0.05), mortality (RR, 0.82; 95% CI, 0.36, 1.88; z = 0.47, P = 0.64), or ICU transfer (RR, 1.09; 95% CI, 0.57, 2.09; z = 0.26, P = 0.79) during ARF treatment. However, the subgroup analysis showed that HFNC therapy may decrease the rate of escalation of respiratory support (RR, 0.71; 95% CI, 0.53, 0.97; z = 2.15, P = 0.03) and the intubation rate (RR, 0.71; 95% CI, 0.53, 0.97; z = 2.15, P = 0.03) when ARF patients were treated with HFNC therapy for ≥24 h compared with COT.ConclusionsHFNC therapy was similar to COT in ARF patients. The subgroup analysis showed that HFNC therapy may decrease the rate of escalation of respiratory support and the intubation rate when ARF patients were treated with HFNC for ≥24 h compared with COT. Further high-quality, large-scale studies are needed to confirm our results.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0525-0) contains supplementary material, which is available to authorized users.

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

“…HFNC is a novel oxygen therapy developed in recent years, in which oxygen at a certain concentration mixed with highflow gas is directly delivered to patients through a nonsealed nasal cannula [6,7]. is oxygen therapy has been assessed by many studies and can be applied to patients with acute hypoxemic respiratory failure, status-post surgery, and respiratory failure without tracheal intubation, immunosuppression, and cardiac insufficiency, thus effectively improving oxygenation [8][9][10][11][12][13][14][15]. However, few studies have confirmed the efficacy of HFNC in treating bronchial asthma, focusing mainly on pediatric and neonatal patients [16,17].…”

High-flow nasal cannula therapy as apneic oxygenation during endotracheal intubation in critically ill patients in the intensive care unit: a systematic review and meta-analysis

“…www.nature.com/scientificreports www.nature.com/scientificreports/ HFNC was initially utilized as an alternative breathing support for premature infants to maintain positive airway pressure [37][38][39] ; however, there is a propensity to use HFNC therapy in adults with respiratory distress 8,40,41 . In the latest meta-analysis conducted by Zhu and colleague 40 , HFNC had significantly effect on reducing post-extubation respiratory failure rate, respiratory rates, and increasing PaO 2 , comparing with conventional oxygen therapy in patients after planned extubation.…”

How to use humidified high‐flow nasal cannula in breathless adults in the emergency department

“…The same groups advise against HHFNC for those patients in whom alveolar collapse is the main mechanism of dyspnoea, as the PEEP delivered by HHFNC is inferior to that delivered by full facemasks. This makes HHFNC of less use in obesity, acute pulmonary oedema or following abdominal surgery . It is also considered contraindicated in epistaxis, base of skull fracture, upper airway surgery or nasal obstruction because of the risk of mucosal ulceration from the nasal prongs, decreased access for certain surgical procedures and an unobstructed path to the HHFNC airflow …”

“…HHFNC has been recommended for spontaneously breathing adults with hypoxemia, or discomfort from increased respiratory effort. 5,[8][9][10][11] It has been used in adults with acute respiratory failure, 12 pneumonia, 12 immunocompromise, 13 during airway procedures, 14 post-extubation 15 and palliative care. 3,16 The utility of HHFNC in hypercapnic respiratory failure is still uncertain.…”

“…This makes HHFNC of less use in obesity, acute pulmonary oedema or following abdominal surgery. 5,11,18 It is also considered contraindicated in epistaxis, base of skull fracture, upper airway surgery or nasal obstruction because of the risk of mucosal ulceration from the nasal prongs, decreased access for certain surgical procedures and an unobstructed path to the HHFNC airflow. 5…”