Can high-flow nasal cannula reduce the rate of reintubation in adult patients after extubation? A meta-analysis

Yue-Nan Ni, Jian Luo, He Yu, Dan Liu, Bin-Miao Liang, Rong Yao, Zong-An Liang, Yue-Nan Ni, Jian Luo, He Yu, Dan Liu, Bin-Miao Liang, Rong Yao, Zong-An Liang

Abstract

Background: The effects of high flow nasal cannula (HFNC) on adult patients after extubation remain controversial. We aimed to further determine the effectiveness of HFNC in comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).

Methods: The Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trails (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all the controlled study comparing HFNC with NIPPV and COT in adult patients after extubation. The primary outcome was rate of reintubation and the secondary outcomes were intensive care unit (ICU) mortality and length of ICU stay (ICU LOS).

Results: Eight trials with a total of 2936 patients were pooled in our final studies. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with lower rate of reintubation (Z = 2.97, P = 0.003), and the same result was found in the comparison between HFNC and NIPPV (Z = 0.87, P = 0.38). As for the ICU mortality and ICU LOS, we did not find any advantage of HFNC over COT or NIPPV.

Conclusions: In patients after extubation, HFNC is a reliable alternative of NIPPV to reduce rate of reintubation compared with COT.

Keywords: Adult; High flow nasal cannula; Meta-analysis; Mortality; Post-extubation; Prognosis.

Conflict of interest statement

Ethics approval and consent to participate

Each enrolled trial was approved by the corresponding institutional Ethical Committee, and all participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

None of all authors have any financial or non-financial competing interests in this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Risk of bias graph
Fig. 3
Fig. 3
Risk of bias summary
Fig. 4
Fig. 4
Fig. 4 Funnel plot for publicationbias
Fig. 5
Fig. 5
Rate of reintubation. COT, conventional oxygen therapy; CI, confidence interval; HFNC, high-flow nasal cannula; ICU, intensive care unit; NIPPV, noninvasive positive pressure ventilation; SD, standard derivation
Fig. 6
Fig. 6
ICU mortality. COT, conventional oxygen therapy; CI, confidence interval; HFNC, high-flow nasal cannula; NIPPV, noninvasive positive pressure ventilation; SD, standard derivation
Fig. 7
Fig. 7
ICU LOS. COT, conventional oxygen therapy; CI, confidence interval; HFNC, high-flow nasal cannula; ICU, intensive care unit; LOS, length of stay; NIPPV, noninvasive positive pressure ventilation; SD, standard derivation

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