Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

Yun Peng; Bing Dai; Hong-Wen Zhao; Wei Wang; Jian Kang; Hai-Jia Hou; Wei Tan

doi:10.1177/17534666221113663

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

Ther Adv Respir Dis. 2022 Jan-Dec:16:17534666221113663. doi: 10.1177/17534666221113663.

Authors

Yun Peng¹, Bing Dai², Hong-Wen Zhao², Wei Wang², Jian Kang², Hai-Jia Hou², Wei Tan³

Affiliations

¹ Department of Intensive Care Medicine, The Second Hospital of Jiaxing, Jiaxing, China.
² Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
³ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang 110001, China.

Abstract

Background: High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain.

Objectives: We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19.

Methods: We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO₂/FiO₂, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)].

Results: In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51-0.84, p = 0.0008, I² = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63-2.32, p = 0.57, I² = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51-1.17, p = 0.23, I² = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO₂/FiO₂, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups.

Conclusion: Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or CPAP group. Future large sample RCTs are necessary to prove our findings.

Registration: This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).

Keywords: COVID-19; CPAP; helmet; high-flow nasal cannula; noninvasive mechanical ventilation.

Publication types

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

MeSH terms

COVID-19* / therapy
Cannula
Humans
Noninvasive Ventilation* / adverse effects
Noninvasive Ventilation* / methods
Oxygen Inhalation Therapy / adverse effects
Respiration, Artificial
Respiratory Insufficiency* / therapy