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The effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis
Abstract
Background The effects of high flow nasal cannula (HFNC) on adult patients when used before mechanical ventilation (MV) are unclear. We aimed to determine the effectiveness of HFNC when used before MV by comparison to conventional oxygen therapy (COT) and noninvasive positive pressure ventilation (NIPPV).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 when used before MV in adult patients. 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 Eight trials with a total of 1084 patients were pooled in our final studies. No significant heterogeneity was found in outcome measures. Compared both with COT and NIPPV, HFNC could reduce both of the rate of endotracheal intubation (OR 0.62, 95% CI 0.38-0.99, P=0.05; OR 0.48, 95% CI 0.31-0.73, P=0.0006) and ICU mortality (OR 0.47, 95% CI 0.24-0.93, P=0.03; OR 0.36, 95% CI 0.20-0.63, P=0.0004). As for the ICU LOS, we did not find any advantage of HFNC over COT or NIPPV.Conclusions When used before MV, HFNC can improve the prognosis of patients compared both with the COT and NIPPV.
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“A systematic review and meta-analysis of nine RCTs [2] showed that HFNC reduces intubation compared with conventional oxygen (RR 0.85; 95% CI 0.74–0.99) but does not affect the risk of death or ICU length of stay [412–414].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [412]
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Metadata
- Authors
- Ni, Y.-N., Luo, J., Yu, H., Liu, D., Liang, B.-M., & Liang, Z.-A.
- Affiliations
- Sichuan University (CN)
- Corresponding author
- Liang, Zong-An
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 36
- Issue
- 2
- Pages
- 226-233
- ISSN
- 0735-6757 (ISSN-L)
- OpenAlex
- W2739506637
- Cited by
- 112
- References
- 58
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 11 · 2022: 16 · 2021: 24 · 2020: 39 · 2019: 6 · 2018: 3
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sichuan Science and Technology Agency (2014SZ0010)
- National Natural Science Foundation of China (81600057)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- high-flow nasal cannula, endotracheal intubation, ICU mortality, ICU length of stay, noninvasive positive pressure ventilation, conventional oxygen therapy, mechanical ventilation, adult patients
- MeSH terms
- Cannula, Clinical Trials as Topic, Critical Care, Humans, Intubation, Intratracheal, Oxygen Inhalation Therapy, Positive-Pressure Respiration, Respiration, Artificial
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