High-flow nasal cannula oxygen versus non-invasive ventilation in patients with COVID-19: a systematic review and meta-analysis

ABSTRACT

Introduction: High-flow nasal cannula oxygen (HFNC) and non-invasive ventilation (NIV), have been widely used in patients with acute hypoxic respiratory failure (AHRF) due to coronavirus disease 2019 (COVID-19). Their impact on clinical outcomes of COVID-19 is uncertain. Therefore, we performed this meta-analysis to evaluate the effect of HFNC vs. NIV in COVID-19-related AHRF. Method(s) PubMed and Embase were searched through December 15, 2021, for eligible studies comparing the outcomes of HFNC vs. NIV in patients with COVID-19-related AHRF. Our primary outcome was intubation rate. The secondary outcomes were mortality, length of hospital stay (LOS), and changes in PaO2/FiO2 ratio. Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were obtained by using a random-effect model. Result(s) Eleven studies involving 1380 patients (525 received HFNC and 855 received NIV) were included. There were no differences in intubation rate, mortality, or LOS between the two groups (Figure). HFNC achieved a lower level of PaO2/FiO2 ratio improvement than NIV (MD 0.40 days, 95% CI 0.08, 0.72, P=0.02, Figure). Conclusion(s) Our study demonstrated that despite NIV achieving a higher level of PaO2/FiO2 ratio improvement than HFNC, HFNC is non-inferior to NIV in intubation, mortality, and LOS among patients with COVID-19-related AHRF. Large-scale RCTs are needed to validate our findings.