Expert Rev Respir Med. 2021 Jun 3. doi: 10.1080/17476348.2021.1937131. Online ahead of print.
BACKGROUND: High flow nasal oxygen (HFNO) therapy has been widely used in intensive care units (ICU); however, its efficacy remains inconclusive. This systematic review and meta-analysis aimed to compare the efficacy of HFNO therapy with that of alternative noninvasive oxygen therapies such as conventional oxygen therapy (COT) and noninvasive ventilation (NIV) in ICU.
METHODS: A Pubmed, Embase, Web of Science, Cochrane Library database search, which identified studies that assessed the outcomes of HFNO in adult ICU patients, was performed in March 2020. Results: The meta-analysis ultimately included 17 clinical studies, of which 11 were randomized control studies. Compared with the overall effect of COT and NIV, HFNO was associated with a low incidence of pneumonia (95% CI: 0.6-0.99, P = 0.04) and improvement in lowest pulse oxygen saturation (SpO₂) during oxygenation (95% CI: 0.02-1.61; P = 0.04). However, no differences were detected in the following outcomes: length of ICU stay, the rate of intubation or reintubation, mortality at day 28, hospital mortality, and SpO₂ at the end of oxygen therapy (all P > 0.05).
CONCLUSIONS: In adult patients in ICU, HFNO may improve oxygenation and decrease pneumonia rate without affecting the length of ICU stay, intubation or reintubation rate, mortality, and SpO₂ at the end of oxygen therapy.