Abstract
Background
Acute respiratory failure (ARF) is a common cause of presentation to the Emergency
Department (ED). High flow nasal cannula (HFNC) has been introduced as an alternative
way to administer oxygen.
Objectives
We performed a systematic review and meta-analysis of randomized controlled trials
(RCTs) comparing HFNC with conventional oxygen therapy (COT) and noninvasive ventilation
(NIV) exclusively in the ED setting.
Methods
Inclusion criteria were: RCTs on adults with ARF admitted to the ED, investigating
HFNC vs. COT or other modes of ventilation. Trials that compared HFNC support outside
the ED, were published as an abstract, or nonrandomized were excluded.
Results
Four RCTs comparing HFNC with COT and one HFNC to NIV met the criteria. Overall, 775
patients were included. The meta-analysis of the studies comparing HFNC and COT showed
no differences in intubation requirement, treatment failure, hospitalization, or mortality.
Intolerance was significantly higher with HFNC (risk ratio 6.81 95% confidence interval
1.18–39.19; p = 0.03). In the only available RCT comparing HFNC with NIV, no difference was found
for intubation rate, treatment failure, tolerance, and dyspnea.
Conclusions
We did not find any benefit of HFNC compared with COT and NIV in terms of intubation
requirement, treatment failure, hospitalization, and mortality; COT was better tolerated.
Keywords
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Article info
Publication history
Published online: August 14, 2019
Accepted:
June 22,
2019
Received in revised form:
June 4,
2019
Received:
March 28,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- High Flow Nasal Cannula vs. Conventional Oxygen Therapy and Noninvasive Ventilation: Respiratory Distress or Respiratory Failure?Journal of Emergency MedicineVol. 59Issue 3
- PreviewI read with interest the review by Tinelli et al. in the September 2019 issue of the Journal (1). I agree with Tinelli et al. that high flow nasal cannula was less tolerated than conventional oxygen therapy (COT) in the articles included in the meta-analysis. There are some things about the definition of respiratory failure that should be addressed.
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