High-flow nasal oxygen superior to NIV, COT in acute respiratory failure management

High-flow nasal oxygen (HFNO), compared with noninvasive ventilation (NIV), appears to improve clinical outcomes in patients with acute respiratory failure (ARF), results of a study have shown. In postextubation management, HFNO reduces reintubations and leads to patient comfort relative to conventional oxygen therapy (COT). Moreover, it results in fewer harms than NIV or COT.

The investigators conducted English-language searches of Medline, Embase, Cinahl, and Cochrane Library from January 2000 to July 2020 and systematic review reference lists. They identified 29 randomized controlled trials that assessed HFNO vs NIV or COT.

One investigator extracted data, which was verified by another; two investigators evaluated risk of bias, while a consensus determined evidence certainty.

The findings were reported separately for HFNO vs NIV, for HFNO vs COT, and by initial or postextubation management. Compared with NIV, HFNO was found to reduce all-cause mortality, intubation, and hospital-acquired pneumonia and to boost patient comfort in initial ARF management (low-certainty evidence) but not in postextubation management.

In postextubation ARF management, HFNO appeared to reduce reintubation as well as improve patient comfort compared with COT (low-certainty evidence).

“Broad applicability, including required clinician and health system experience and resource use, is not well known,” the authors said.

The study had certain limitations. First, the trials differed in populations enrolled, ARF causes, and treatment protocols. Second, trial design, sample size, treatment duration and follow-up, and results reporting were not adequate enough to properly assess outcomes. Finally, protocols, clinician and health system training, cost, and resource use were poorly characterized.