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Original Research |

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

Competing interests

None of all authors have any financial or non-financial competing interests in this manuscript.

1Department of Respiratory and Critical Care medicine

2Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, 610041, China

Corresponding authors A. Bin-Miao Liang, Address: No.37 Guoxue Alley, Chengdu, 610041, China. B. Zong-An Liang, Address: No.37 Guoxue Alley, Chengdu, 610041, China.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.01.004
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Abstract

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, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all the controlled studies that compared HFNC with NIPPV and COT in adult patients having ARF. The primary outcome was the rate of endotracheal intubation and the secondary outcomes were intensive care unit (ICU) mortality and length of ICU stay (ICU LOS).

Results  Eighteen trials with a total of 3881 patients were pooled in our final studies. Except for ICU mortality (I2=67%, χ2=12.21, P=0.02) and rate of endotracheal intubation (I2=63%, χ2=13.51, P=0.02) 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=0.01), while no significant difference was found in the comparison with NIPPV (Z=1.40, P=0.16). As for the ICU mortality and ICU LOS, HFNC did not show any advantage over either COT or NIPPV.

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


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