Cochrane · systematic review · CD010172
High‐flow nasal cannulae for respiratory support in adult intensive care patients
Lewis, SR, Baker, PE, Parker, R, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
16
current version
GRADE rated
15
No studies
1
Included studies
NR
No studies 1 · 6.3%Ungraded 0 · 0%Very low 6 · 37.5%Low 7 · 43.8%Moderate 2 · 12.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyHFNC compared to standard oxygen therapy for respiratory support in adult intensive care patients
Population: adults in the ICU, requiring respiratory support
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment failure (escalation of respiratory therapy to NIV, NIPPV or invasive ventilation) Measured up to 28 days HFNC vs standard oxygen therapy | RR 0.62 [0.45, 0.86] | 15 studies · 3044 participants | Low Downgraded: risk of bias, inconsistency |
In‐hospital mortality (up to 90 days; included studies reported in‐hospital mortality, and mortality up to 28 days, up to ICU discharge, and at unspecified time points) HFNC vs standard oxygen therapy | RR 0.96 [0.82, 1.11] | 11 studies · 2673 participants | Moderate Downgraded: inconsistency |
Adverse events Respiratory infection (pneumonia) Nasal mucosa or skin trauma HFNC vs standard oxygen therapy | RR 0.72 [0.48, 1.09] | 4 studies · 1057 participants | Moderate Downgraded: imprecision |
Length of ICU stay HFNC vs standard oxygen therapy | no estimate extracted | 7 studies · 1014 participants | Low Downgraded: risk of bias, inconsistency |
Respiratory effects: PaO2/FiO2 ratio up to 24 hours after initiation of therapy HFNC vs standard oxygen therapy | no estimate extracted | 5 studies · 600 participants | Very low Downgraded: risk of bias, inconsistency |
Comfort (short‐term effect) Measured up to 24 hours, scales were standardised to allow comparison; higher numbers indicate more comfort HFNC vs standard oxygen therapy | no estimate extracted | 4 studies · 662 participants | Very low Downgraded: imprecision, inconsistency |
Comfort (long‐term effect) Measured at more than 24 hours, scales were standardized to allow comparison; higher numbers indicate more comfort HFNC vs standard oxygen therapy | no estimate extracted | 2 studies · 445 participants | Very low Downgraded: imprecision, inconsistency |
HFNC compared to NIPPV or NIV for respiratory support in adult intensive care patients
Population: adults in the ICU, requiring respiratory support
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment failure (escalation of respiratory therapy to NIV, NIPPV or invasive ventilation) Measured up to 28 days HFNC vs NIPPV or NIV | RR 0.98 [0.78, 1.22] | 5 studies · 1758 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
In‐hospital mortality (up to 90 days; included studies reported in‐hospital mortality, and mortality up to 28 days and up to ICU discharge) HFNC vs NIPPV or NIV | RR 0.92 [0.64, 1.31] | 5 studies · 1758 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events Respiratory infection (pneumonia) HFNC vs NIPPV or NIV | RR 0.51 [0.17, 1.52] | 3 studies · 1750 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Barotrauma (pneumothorax) HFNC vs NIPPV or NIV | RR 1.15 [0.42, 3.14] | 1 study · 830 participants | Low Downgraded: imprecision |
Nasal mucosa or skin trauma HFNC vs NIPPV or NIV | no estimate extracted | NR | No studies |
Length of ICU stay HFNC vs NIPPV or NIV | no estimate extracted | 2 studies · 246 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Respiratory effects: PaO2/FiO2 ratio up to 24 hours after initiation of therapy HFNC vs NIPPV or NIV | no estimate extracted | 3 studies · 1086 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Comfort (short‐term effect) Measured up to 24 hours, scales were standardized to allow comparison; higher numbers indicate more comfort HFNC vs NIPPV or NIV | no estimate extracted | 2 studies · 258 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Comfort (long‐term effect) Measured at more than 24 hours HFNC vs NIPPV or NIV | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |
HFNC compared to standard oxygen therapy for respiratory support in adult intensive care patients
Population: adults in the ICU, requiring respiratory support
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment failure (escalation of respiratory therapy to NIV, NIPPV or invasive ventilation) Measured up to 28 days HFNC vs standard oxygen therapy | RR 0.62 [0.45, 0.86] | 15 studies · 3044 participants | Low Downgraded: risk of bias, inconsistency |
In‐hospital mortality (up to 90 days; included studies reported in‐hospital mortality, and mortality up to 28 days, up to ICU discharge, and at unspecified time points) HFNC vs standard oxygen therapy | RR 0.96 [0.82, 1.11] | 11 studies · 2673 participants | Moderate Downgraded: inconsistency |
Adverse events Respiratory infection (pneumonia) Nasal mucosa or skin trauma HFNC vs standard oxygen therapy | RR 0.72 [0.48, 1.09] | 4 studies · 1057 participants | Moderate Downgraded: imprecision |
Length of ICU stay HFNC vs standard oxygen therapy | no estimate extracted | 7 studies · 1014 participants | Low Downgraded: risk of bias, inconsistency |
Respiratory effects: PaO2/FiO2 ratio up to 24 hours after initiation of therapy HFNC vs standard oxygen therapy | no estimate extracted | 5 studies · 600 participants | Very low Downgraded: risk of bias, inconsistency |
Comfort (short‐term effect) Measured up to 24 hours, scales were standardised to allow comparison; higher numbers indicate more comfort HFNC vs standard oxygen therapy | no estimate extracted | 4 studies · 662 participants | Very low Downgraded: imprecision, inconsistency |
Comfort (long‐term effect) Measured at more than 24 hours, scales were standardized to allow comparison; higher numbers indicate more comfort HFNC vs standard oxygen therapy | no estimate extracted | 2 studies · 445 participants | Very low Downgraded: imprecision, inconsistency |
HFNC compared to NIPPV or NIV for respiratory support in adult intensive care patients
Population: adults in the ICU, requiring respiratory support
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment failure (escalation of respiratory therapy to NIV, NIPPV or invasive ventilation) Measured up to 28 days HFNC vs NIPPV or NIV | RR 0.98 [0.78, 1.22] | 5 studies · 1758 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
In‐hospital mortality (up to 90 days; included studies reported in‐hospital mortality, and mortality up to 28 days and up to ICU discharge) HFNC vs NIPPV or NIV | RR 0.92 [0.64, 1.31] | 5 studies · 1758 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events Respiratory infection (pneumonia) HFNC vs NIPPV or NIV | RR 0.51 [0.17, 1.52] | 3 studies · 1750 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Barotrauma (pneumothorax) HFNC vs NIPPV or NIV | RR 1.15 [0.42, 3.14] | 1 study · 830 participants | Low Downgraded: imprecision |
Nasal mucosa or skin trauma HFNC vs NIPPV or NIV | no estimate extracted | NR | No studies |
Length of ICU stay HFNC vs NIPPV or NIV | no estimate extracted | 2 studies · 246 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Respiratory effects: PaO2/FiO2 ratio up to 24 hours after initiation of therapy HFNC vs NIPPV or NIV | no estimate extracted | 3 studies · 1086 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Comfort (short‐term effect) Measured up to 24 hours, scales were standardized to allow comparison; higher numbers indicate more comfort HFNC vs NIPPV or NIV | no estimate extracted | 2 studies · 258 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Comfort (long‐term effect) Measured at more than 24 hours HFNC vs NIPPV or NIV | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision |