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Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and

Yun Peng¹, Bing Dai², Hong-Wen Zhao²

¹Department of Intensive Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China.

Therapeutic Advances in Respiratory Disease

|July 21, 2022

Abstract

Background:

High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain.

Objectives:

We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19.

Methods:

We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO₂/FiO₂, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)].

Results:

In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51-0.84, p = 0.0008, I² = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63-2.32, p = 0.57, I² = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51-1.17, p = 0.23, I² = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO₂/FiO₂, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups.

Conclusion:

Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or CPAP group. Future large sample RCTs are necessary to prove our findings.

Registration:

This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).

Keywords:

COVID-19 CPAP helmet high-flow nasal cannula noninvasive mechanical ventilation

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