High-Flow Nasal Cannula Versus Noninvasive Ventilation in the Treatment of Hypercapnic Respiratory Failure: Meta-Analysis of Randomized Controlled Trials.
Journal of Evidence-Based Medicine · 2026-06-01 · Meta-analysis
Abstract
AIM: To evaluate efficacy and safety of high-flow nasal cannula (HFNC) versus noninvasive ventilation (NIV) in adults with hypercapnic respiratory failure (HRF). METHODS: We conducted a meta-analysis of randomized controlled trials from PubMed, Embase, The Cochrane Library, Wanfang, CNKI, and Weipu comparing HFNC with NIV in HRF patients. Primary outcomes were mortality and endotracheal intubation. Secondary outcomes included blood gas values, hospital/ intensive care unit (ICU) length of stay, nasal skin breakdown, and comfort. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated. RESULTS: Twenty trials involving 1835 patients were included. No significant differences were observed in mortality (RR, 0.94; 95% CI, 0.69 to 1.28), endotracheal intubation (RR, 0.87; 95% CI, 0.71 to 1.06), PaCO2 (MD, -0.87 mmHg; 95% CI, -2.98 to 1.25) or PaO2 (MD, 2.67 mmHg; 95% CI, -0.66 to 6.01). However, HFNC significantly reduced hospital stay (MD, -0.69 days; 95% CI, -1.08 to -0.30) and ICU stay (MD, -0.98 days; 95% CI, -1.50 to -0.45), lowered nasal skin breakdown risk (RR, 0.20; 95% CI, 0.09 to 0.45) and improved comfort (MD, -1.19; 95% CI, -1.98 to -0.41). Subgroup and sensitivity analyses confirmed the principal findings. CONCLUSIONS: HFNC was not significantly different from NIV for mortality and endotracheal intubation in HRF but was associated with shorter hospital and ICU stays, reduced nasal facial skin breakdown and improved comfort. Larger trials in diverse populations are needed.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
CPAP & NIV · High-flow nasal oxygen · Mortality & survival
Related articles
- High-Flow Nasal Oxygen Versus Conventional Oxygen Therapy and Non-Invasive Ventilation for Acute Respiratory Failure in the Emergency Department: A Systematic Review and Meta-Analysis. (Emerg Med Australas, 2026)
- High-Flow Nasal Cannula Versus Noninvasive Ventilation for Prevention of Reintubation in High-Risk Critically Ill Patients (HIGH-FLOW OXY): An Informative Systematic Review and Meta-Analysis. (Crit Care Explor, 2026)
- Effect of non-invasive ventilation and high-flow nasal cannula on hospital mortality in COVID-19-induced acute respiratory failure: a meta-analysis. (Einstein (Sao Paulo), 2026)
- Respiratory support in the emergency department: A systematic review and meta-analysis. (Worldviews Evid Based Nurs, 2024)
- High-flow nasal cannula versus non-invasive ventilation for acute hypercapnic respiratory failure in adults: a systematic review and meta-analysis of randomized trials. (Crit Care, 2022)
- Awake Prone Positioning, High-Flow Nasal Oxygen and Non-Invasive Ventilation as Non-Invasive Respiratory Strategies in COVID-19 Acute Respiratory Failure: A Systematic Review and Meta-Analysis. (J Clin Med, 2022)