Effects of high-flow nasal oxygen cannula versus other noninvasive ventilation in extubated patients: a systematic review and meta-analysis of randomized controlled trials.

ABSTRACT

OBJECTIVES: A systematic review and meta-analysis were performed to compare the effects of high-flow nasal oxygen cannula (HFNC) and noninvasive ventilation (NIV) in extubated patients with respiratory insufficiency. METHODS: The Cochrane Library, PubMed, and ClinicalTrials.gov were searched from inception to 28 February 2021, to identify randomized controlled trials. The primary outcome was reintubation within 24-72 hours after a planned extubation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Six articles with1746 patients were included. The effect of HFNC on the reintubation rate was noninferior to that of NIV (OR = 1.11, 95% CI 0.85-1.44). The rate of treatment failure was 20.40% with HFNC versus 20.92% with NIV; this difference was nonsignificant (OR = 0.97, 95% CI 0.72-1.32, P = 0.85). HFNC reduced the rates of skin lesion occurrence (10.28% versus 23.82%, OR = 0.37, 95% CI 0.26-0.53, P < 0.00001) and post-extubation respiratory failure (23.76% versus 25.56%, OR = 0.64, 95% CI 0.46-0.88, P = 0.006), compared with NIV. CONCLUSIONS: In extubated patients, HFNC was noninferior to NIV in the rate of reintubation and treatment failure. Compared with NIV, HFNC decreased the occurrence of skin lesions and post-extubation respiratory failure.