Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis
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 unce...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-07-01
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| Series: | Therapeutic Advances in Respiratory Disease |
| Online Access: | https://doi.org/10.1177/17534666221113663 |
| _version_ | 1797853308437659648 |
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| author | Yun Peng Bing Dai Hong-wen Zhao Wei Wang Jian Kang Hai-jia Hou Wei Tan |
| author_facet | Yun Peng Bing Dai Hong-wen Zhao Wei Wang Jian Kang Hai-jia Hou Wei Tan |
| author_sort | Yun Peng |
| collection | DOAJ |
| description | 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, PaO 2 /FiO 2 , 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, I 2 = 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, I 2 = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51–1.17, p = 0.23, I 2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO 2 /FiO 2 , 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). |
| first_indexed | 2024-04-09T19:47:25Z |
| format | Article |
| id | doaj.art-35e02f2a25654d8bac58c5949c1174cc |
| institution | Directory Open Access Journal |
| issn | 1753-4666 |
| language | English |
| last_indexed | 2024-04-09T19:47:25Z |
| publishDate | 2022-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Respiratory Disease |
| spelling | doaj.art-35e02f2a25654d8bac58c5949c1174cc2023-04-03T13:33:44ZengSAGE PublishingTherapeutic Advances in Respiratory Disease1753-46662022-07-011610.1177/17534666221113663Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysisYun PengBing DaiHong-wen ZhaoWei WangJian KangHai-jia HouWei TanBackground: 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, PaO 2 /FiO 2 , 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, I 2 = 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, I 2 = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51–1.17, p = 0.23, I 2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO 2 /FiO 2 , 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).https://doi.org/10.1177/17534666221113663 |
| spellingShingle | Yun Peng Bing Dai Hong-wen Zhao Wei Wang Jian Kang Hai-jia Hou Wei Tan Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis Therapeutic Advances in Respiratory Disease |
| title | Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis |
| title_full | Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis |
| title_fullStr | Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis |
| title_full_unstemmed | Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis |
| title_short | Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis |
| title_sort | comparison between high flow nasal cannula and noninvasive ventilation in covid 19 patients a systematic review and meta analysis |
| url | https://doi.org/10.1177/17534666221113663 |
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