High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review

Yang Li; Cong Li; Wei Chang; Ling Liu

doi:10.1136/bmjopen-2022-067879

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review

BMJ Open. 2023 Mar 30;13(3):e067879. doi: 10.1136/bmjopen-2022-067879.

Authors

Yang Li¹, Cong Li¹, Wei Chang¹, Ling Liu²

Affiliations

¹ Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
² Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China liulingdoctor@126.com.

Abstract

Objective: This study aimed to investigate the effect of high-flow nasal cannula therapy (HFNC) versus conventional oxygen therapy (COT) on intubation rate, 28-day intensive care unit (ICU) mortality, 28-day ventilator-free days (VFDs) and ICU length of stay (ICU LOS) in adult patients with acute respiratory failure (ARF) associated with COVID-19.

Design: Systematic review and meta-analysis.

Data sources: PubMed, Web of Science, Cochrane Library and Embase up to June 2022.

Eligibility criteria for selecting studies: Only randomised controlled trials or cohort studies comparing HFNC with COT in patients with COVID-19 were included up to June 2022. Studies conducted on children or pregnant women, and those not published in English were excluded.

Data extraction and synthesis: Two reviewers independently screened the titles, abstracts and full texts. Relevant information was extracted and curated in the tables. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to assess the quality of randomised controlled trials or cohort studies. Meta-analysis was conducted using RevMan V.5.4 computer software using a random effects model with a 95% CI. Heterogeneity was assessed using Cochran's Q test (χ²) and Higgins I² statistics, with subgroup analyses to account for sources of heterogeneity.

Results: Nine studies involving 3370 (1480 received HFNC) were included. HFNC reduced the intubation rate compared with COT (OR 0.44, 95% CI 0.28 to 0.71, p=0.0007), decreased 28-day ICU mortality (OR 0.54, 95% CI 0.30 to 0.97, p=0.04) and improved 28-day VFDs (mean difference (MD) 2.58, 95% CI 1.70 to 3.45, p<0.00001). However, HFNC had no effect on ICU LOS versus COT (MD 0.52, 95% CI -1.01 to 2.06, p=0.50).

Conclusions: Our study indicates that HFNC may reduce intubation rate and 28-day ICU mortality, and improve 28-day VFDs in patients with ARF due to COVID-19 compared with COT. Large-scale randomised controlled trials are necessary to validate our findings.

Prospero registration number: CRD42022345713.

Keywords: COVID-19; adult intensive & critical care; respiratory infections.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / therapy
Cannula
Child
Female
Humans
Intubation, Intratracheal
Noninvasive Ventilation*
Oxygen
Oxygen Inhalation Therapy
Pregnancy
Respiratory Distress Syndrome* / therapy
Respiratory Insufficiency* / therapy

Substances

Oxygen