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Published on: January 29, 2011
High-flow nasal oxygen therapy in patients with hypercapnic respiratory failure: A systematic review and
Lili Guan1, Jianyi Niu1, Qiaoyun Huang1
1Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Background:
Noninvasive ventilation (NIV) is recommended as the first-line respiratory support method for patients with hypercapnic respiratory failure (HRF). However, the need for well-trained operators and the occurrence of treatment discomfort may limit its efficacy. High-flow nasal oxygen therapy (HFNO) is a convenient respiratory support with user-friendly operation, high comfort, and good compliance. This systematic review and meta-analysis was performed to compare the therapeutic effects of HFNO and other noninvasive respiratory support methods [NIV or conventional oxygen therapy (COT)] in patients with acute HRF (AHRF) or chronic HRF (CHRF).
Methods:
We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to May 2024 to identify randomized clinical trials comparing the impact of HFNO and NIV/COT in adults with HRF.
Results:
Sixteen studies (1630 patients) were included. Compared with NIV, HFNO did not improve the primary outcome of PaCO2 in patients with AHRF or CHRF [AHRF: MD = -0.81, 95 % CI = -3.40 to 1.77; CHRF: MD = 1.82, 95 % CI = 0.44 to 3.20]. However, HFNO showed advantages over COT (AHRF: MD = -2.03, 95 % CI = -3.48 to -0.59; CHRF: MD = -2.64, 95 % CI = -4.24 to -1.03).
Conclusions:
The evidence of its clinical efficacy in hypercapnic patients remains inconclusive. Further studies are needed to generate more evidence for the application of HFNO in patients with HRF and to determine the subset of patients for whom may be preferable.
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