The following is a summary of “High-flow nasal cannula oxygen versus conventional oxygen therapy for acute respiratory failure due to COVID-19: a systematic review and meta-analysis,” published in the November 2023 issue of Critical Care by Pape et al.

Despite widespread use, the effectiveness of high-flow nasal cannula oxygen therapy (HFNC) in alleviating acute respiratory failure caused by COVID-19 remains unclear.

Researchers conducted a retrospective study to determine if HFNC reduces the risk of intubation or mortality in COVID-19 patients with acute respiratory failure compared to conventional oxygen therapy (COT).

They searched MEDLINE, Embase, Web of Science, and CENTRAL databases for RCTs and observational studies comparing HFNC to COT in patients with acute respiratory failure due to COVID-19, published in English from inception (December 2022). Excluded were pediatric studies, comparisons of HFNC with noninvasive respiratory support other than COT, and studies without reported intubation or mortality. Two authors independently screened and selected articles, extracted data, and assessed bias risk. Performed fixed-effects or random-effects meta-analysis based on statistical heterogeneity. Primary outcomes were intubation and mortality risk across RCTs, expressed as risk ratios and 95% CI(RR; 95% CI). Observational studies were used for sensitivity analyses.

The results showed 20 studies involving 8,383 patients, including 6 RCTs (2,509 patients) and 14 observational studies (5,874 patients). Combining the 6 RCTs, HFNC, compared with COT, significantly decreased the risk of intubation (RR 0.89, 95% CI 0.80 to 0.98; P=0.02) and shortened hospital stays. However, HFNC did not considerably reduce the mortality risk (RR 0.93, 95% CI 0.77 to 1.11; P=0.40).

They concluded that HFNC therapy reduces intubation needs and hospital stays, offering a valuable weapon in the fight against respiratory failure.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01208-8