High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis

Area of Science:

• Anesthesiology
• Respiratory Medicine
• Otolaryngology

Background:

• High-flow nasal cannula (HFNC) is an emerging alternative to traditional ventilation for laryngeal surgery.
• Limited data exists on HFNC's safety and efficacy compared to tracheal intubation and jet ventilation (JV).

Purpose of the Study:

• To systematically review and compare HFNC with tracheal intubation and JV for oxygenation during laryngeal surgery.
• To aggregate current evidence on the safety and effectiveness of different ventilation methods.

Main Methods:

• Systematic review and meta-analysis of observational and comparative studies.
• Searched multiple databases including PubMed, MEDLINE, Embase, Google Scholar, Cochrane Library, and Web of Science.
• Risk of bias assessed using ROBINS-I, RoB2, and JBI Critical Appraisal Checklist.

Main Results:

• Included 43 studies with 8064 patients; 14 HFNC, 22 JV, 7 comparative.
• HFNC (THRIVE) reduced surgery duration but increased desaturations and need for rescue interventions versus conventional ventilation.
• Safety of JV was comparable to HFNC.

Conclusions:

• HFNC may be effective for oxygenation in selected laryngeal surgery patients, shortening procedure times.
• Conventional ventilation with tracheal intubation may offer superior safety.
• JV presents comparable safety to HFNC in this context.