High-flow nasal oxygen therapy in patients with hypercapnic respiratory failure: A systematic review and meta-analysis.

Abstract

Background: Noninvasive ventilation (NIV) is recommended as the first-line respiratory support method for patients with hypercapnic respiratory failure (HRF). However, the need for well-trained operators and the occurrence of treatment discomfort may limit its efficacy. High-flow nasal oxygen therapy (HFNO) is a convenient respiratory support with user-friendly operation, high comfort, and good compliance. This systematic review and meta-analysis was performed to compare the therapeutic effects of HFNO and other noninvasive respiratory support methods [NIV or conventional oxygen therapy (COT)] in patients with acute HRF (AHRF) or chronic HRF (CHRF).

Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to May 2024 to identify randomized clinical trials comparing the impact of HFNO and NIV/COT in adults with HRF.

Results: Sixteen studies (1630 patients) were included. Compared with NIV, HFNO did not improve the primary outcome of PaCO₂ in patients with AHRF or CHRF [AHRF: MD = -0.81, 95 % CI = -3.40 to 1.77; CHRF: MD = 1.82, 95 % CI = 0.44 to 3.20]. However, HFNO showed advantages over COT (AHRF: MD = -2.03, 95 % CI = -3.48 to -0.59; CHRF: MD = -2.64, 95 % CI = -4.24 to -1.03).

Conclusions: The evidence of its clinical efficacy in hypercapnic patients remains inconclusive. Further studies are needed to generate more evidence for the application of HFNO in patients with HRF and to determine the subset of patients for whom may be preferable.