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.
Critical Care Explorations · 2026-08-01 · Meta-analysis
Abstract
OBJECTIVES: Optimal postextubation respiratory support for critically ill patients at high risk of reintubation remains uncertain. We aimed to compare the efficacy of high-flow nasal cannula (HFNC) vs. noninvasive ventilation (NIV) in preventing reintubation among critically ill adults at high risk of extubation failure. DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov were systematically searched from inception through the latest available date. STUDY SELECTION: HIGH-FLOW OXY is a systematic review and meta-analysis comparing HFNC with NIV in ICU patients at high risk of extubation failure. The primary outcome was short-term reintubation within 3 days postextubation. Secondary outcomes included ICU mortality, ICU length of stay, sepsis, and nosocomial pneumonia. DATA EXTRACTION: Data were extracted using predefined criteria. Risk of bias (RoB) was assessed with the Cochrane tool, and certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation. Random-effects models were used for pooled analyses. Prespecified subgroup analyses included obese patients, very high-risk patients, elderly individuals, and those with acute exacerbations of chronic obstructive pulmonary disease. DATA SYNTHESIS: Fifteen randomized controlled trials (RCTs; n = 2073) were included. HFNC and NIV did not differ significantly in reintubation (odds ratio [OR], 1.19; 95% CI, 0.88-1.59), ICU mortality (OR, 0.74; 95% CI, 0.40-1.38), sepsis (OR, 1.29; 95% CI, 0.71-2.35), nosocomial pneumonia (OR, 1.01; 95% CI, 0.67-1.52), or ICU length of stay (MD -0.37 d; 95% CI, -1.42 to 0.68). Subgroup analyses suggested a higher reintubation risk with HFNC among very high-risk patients (OR, 1.63; 95% CI, 1.05-2.53) and nonoperative obese patients (OR, 2.52; 95% CI, 1.45-4.38). Sensitivity analysis excluding trials at high RoB indicated a potential increase in reintubation with HFNC (OR, 1.32; 95% CI, 1.02-1.71). Overall, certainty of evidence was low across outcomes. CONCLUSIONS: Among ICU patients at high risk of extubation failure, HFNC did not reduce reintubation compared with NIV, and may be associated with increased risk in selected high-risk subgroups. Further adequately powered, risk-stratified RCTs are warranted to define the optimal postextubation respiratory support strategy.
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 in the Treatment of Hypercapnic Respiratory Failure: Meta-Analysis of Randomized Controlled Trials. (J Evid Based Med, 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)