The Effect of High-Flow Nasal Cannula Oxygen Therapy in Acute Respiratory Failure: A Systematic Review

Abstract

Objective To assess the efficacy, comfort and tolerability of high-flow nasal cannula oxygen therapy in patients with acute respiratory failure(ARF). Methods The literature of RCTs concerning high-flow nasal cannula(HFNC) versus usual oxygen care(UOC) in ARF patients was searched using the national and international electronic databases. All relevant studies were screened according to inclusion and exclusion criteria, and then the included studies were evaluated, and finally, the extracted data were analyzed using Rev Man 5.3 software provided by the Cochrane Collaboration. Results eleven RCTs were included in 3 170 patients, of those 1 550 patients were in HFNC group, while 1 620 patients were in UOC group.There was no statistical difference in mortality among in HFNC and UOC group (OR=0.92, 95%CI: 0.70-1.2, P=0.53), neither was the incidence of nosocomial infection (OR=0.85, 95%CI: 0.63-1.15, P=0.3). The incidence of endotracheal intubation was lower in HFNC group than in UOC group.The comfort and tolerablity was greater in HFNC group than that in UOC group. Conclusions No difference in mortality or nosocomial infection was detected in patients with ARF treated with HFNC compared with UOC. However, HFNC seem well tolerated by patients and showed a lower rate of endotracheal intubation . Key words: High-flow nasal cannula oxygen therapy; Respiratory failure; Randomized controlled trial; Mortality; Incidences of intubation