RT Journal Article
SR Electronic
T1 High-Flow Nasal Cannula Versus Noninvasive Ventilation in Patients With COVID-19
JF Respiratory Care
FD American Association for Respiratory Care
SP 1177
OP 1189
DO 10.4187/respcare.09987
VO 67
IS 9
A1 Azizullah Beran
A1 Omar Srour
A1 Saif-Eddin Malhas
A1 Mohammed Mhanna
A1 Hazem Ayesh
A1 Omar Sajdeya
A1 Rami Musallam
A1 Waleed Khokher
A1 Muhamad Kalifa
A1 Khaled Srour
A1 Ragheb Assaly
YR 2022
UL http://rc.rcjournal.com/content/67/9/1177.abstract
AB BACKGROUND: High-flow nasal cannula (HFNC) oxygen and noninvasive ventilation (NIV) have been widely used in patients with acute hypoxic respiratory failure (AHRF) due to COVID-19. However, the impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. Therefore, we performed this meta-analysis to evaluate the effect of HFNC versus NIV in COVID-19-related AHRF.METHODS: Several electronic databases were searched through February 10, 2022, for eligible studies comparing HFNC and NIV in COVID-19-related AHRF. Our primary outcome was intubation. The secondary outcomes were mortality, hospital length of stay (LOS), and PaO2/FIO2 changes. Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% CI were obtained using a random-effect model. Prediction intervals were calculated to indicate the variance in outcomes that would be expected if new studies were conducted in the future.RESULTS: Nineteen studies involving 3,606 subjects (1,880 received HFNC and 1,726 received NIV) were included. There were no differences in intubation (RR 1.01 [95% CI 0.85–1.20], P = .89) or LOS (MD 0.38 d [95% CI −0.61 to 1.37], P = .45) between groups, with consistent results on the subgroup of randomized controlled trials (RCTs). Mortality was lower in NIV (RR 0.81 [95% CI 0.66–0.98], P = .03). However, the prediction interval was 0.41–1.59, and subgroup analysis of RCTs showed no difference in mortality between groups. There was a greater improvement in PaO2/FIO2 with NIV (MD 22.80 [95% CI 5.30–40.31], P = .01).CONCLUSIONS: Our study showed that despite the greater improvement in PaO2/FIO2 with NIV, intubation rates and LOS were similar between HFNC and NIV. Although mortality was lower with HFNC than NIV, the prediction interval included the null value, and there was no difference in mortality between HFNC and NIV on a subgroup of RCTs. Future large-scale RCTs are necessary to support our findings