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Original Research: Critical Care |

Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis

Yue-Nan Ni, MM; Jian Luo, MD; He Yu, MD; Dan Liu, MD; Zhong Ni, MD; Jiangli Cheng, MD; Bin-Miao Liang, MD; Zong-An Liang, MD
Author and Funding Information

Ms Y.-N. Ni and Dr Luo contributed equally to this work.

FUNDING/SUPPORT: This study was partly supported by a grant from the Sichuan Science and Technology Agency [2014SZ0010].

aDepartment of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China

bDepartment of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China

CORRESPONDENCE TO: Bin-Miao Liang, MD, No. 37 Guoxue Alley, Chengdu, 610041, China


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(4):764-775. doi:10.1016/j.chest.2017.01.004
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Background  The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).

Methods  The PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as the Information Sciences Institute Web of Science, were searched for all controlled studies that compared HFNC with NIPPV and COT in adult patients with ARF. The primary outcome was the rate of endotracheal intubation; the secondary outcomes were ICU mortality and length of ICU stay.

Results  Eighteen trials with a total of 3,881 patients were pooled in our final studies. Except for ICU mortality (I2 = 67%, χ2 = 12.21, P = .02) and rate of endotracheal intubation (I2 = 63%, χ2 = 13.51, P = .02) between HFNC and NIPPV, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of endotracheal intubation (z = 2.55, P = .01) while no significant difference was found in the comparison with NIPPV (z = 1.40, P = .16). As for ICU mortality and length of ICU stay, HFNC did not exhibit any advantage over either COT or NIPPV.

Conclusions  In patients with ARF, HFNC is a more reliable alternative than NIPPV to reduce the rate of endotracheal intubation than COT.

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