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.
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.
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.
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.
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.
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Published online: August 14, 2019
Accepted: June 22, 2019
Received in revised form: June 4, 2019
Received: March 28, 2019
© 2019 Elsevier Inc. All rights reserved.
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- 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.