Evidence map›Paper›PMID 30888444›Full record

SynthesisIntensive care medicine2019

High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis.

B Rochwerg, D Granton, D X Wang, Y Helviz, S Einav, J P Frat, A Mekontso-Dessap, A Schreiber, E Azoulay, A Mercat and 8 more

9 registry-linked trialsAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 9 registered trials, which are not on this map. Cited by 239 papers, 21 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
239citing papers in PubMed, 21 pooled it
50.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04725084 completednot on this mapstarted 2020, after this paper: background citation

Comparison of Non-invasive Oxygenation Strategies in ICU Patients Admitted for Covid-19 Acute Respiratory Distress Syndrome

TypeobservationalSponsorCentre Hospitalier Intercommunal de Toulon La Seyne sur MerRan2020 to 2020Enrolled355ConditionsSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)ArmsUse of High Flow Nasal Cannula alone, Use of Non-invasive Ventilation, Use of Continuous Positive Airway Pressure
NCT04934163 nacompletednot on this mapstarted 2021, after this paper: background citation

Effect of Flow Rates of Postextubation High-flow Nasal Cannula on Extubation Outcome: An Open-label, Randomized Controlled Trial

TypeinterventionalSponsorNational Taiwan University HospitalRan2021 to 2023Enrolled180ConditionsHypoxemic Respiratory FailureArmsFlow rate setting of high-flow nasal cannula (initially 60L/min), Flow rate setting of high-flow nasal cannula (initially 40L/min)
NCT04971148 naterminatednot on this mapstarted 2022, after this paper: background citation

Correlation of Peak Tidal Inspiratory Flow Measured Before and After Extubation in Adult Patients With Hypoxemia, and Patients' Responses to Different Flows Above Their Peak Tidal Inspiratory Flow During High Flow Nasal Cannula Therapy

TypeinterventionalSponsorRush University Medical CenterRan2022 to 2023Enrolled5ConditionsHypoxemic Respiratory FailureArmsHFNC flow set at patient peak tidal inspiratory flow, HFNC flow set at 1.33 times of patient peak tidal inspiratory flow, HFNC flow set at 1.67 times of patient peak tidal inspiratory flow, HFNC flow set at 2 times of patient peak tidal inspiratory flow
NCT05011877 recruitingnot on this mapstarted 2021, after this paper: background citation

A Strategy to Improve Management and Prolong LIFe Without Readmission for hYpercapnic Patients: The Simplify Project

TypeobservationalSponsorUnity Health TorontoRan2021 to 2026Enrolled50ConditionsAcute Hypercapnic Respiratory FailureArmsHigh-flow nasal cannula therapy
NCT05910788 naunknown statusnot on this mapstarted 2023, after this paper: background citation

High-Flow Nasal Catheter (HFNC) Compared With Conventional Oxygenation During the Perioperative Period of Patients Undergoing Thoracic Surgery.

TypeinterventionalSponsorFederal University of Rio Grande do SulRan2023 to 2024Enrolled90ConditionsThoracic SurgeryArmshigh flow nasal cannula
NCT06228703 nacompletednot on this mapstarted 2024, after this paper: background citation

The Effects of Different Flow Settings on Lung Impedance Using Two New HFNC Devices: A Randomized Crossover Study on Healthy Volunteers

TypeinterventionalSponsorRush University Medical CenterRan2024 to 2024Enrolled26ConditionsHealthyArmsHigh-flow nasal cannula device with flow setting at 40 L/min or higher
NCT06489379 naunknown statusnot on this mapstarted 2024, after this paper: background citation

High Flow Nasal Oxygen for Acute Hypoxemic Respiratory Failure in the Emergency Room: the GLAMOUR Study

TypeinterventionalSponsorFondazione Policlinico Universitario Agostino Gemelli IRCCSRan2024 to 2026Enrolled234ConditionsRespiratory Distress Syndrome, AdultArmshigh flow nasal cannula, standard oxygen
NCT06746363 completednot on this mapstarted 2022, after this paper: background citation

The Effectiveness of High-flow Nasal Cannula After Extubation in Patients

Typeobservational_patient_registrySponsorChang Gung Memorial HospitalRan2022 to 2024Enrolled110ConditionsPost Extubation Respiratory Failure
NCT07536477 narecruitingnot on this mapstarted 2026, after this paper: background citation

High-flow Nasal Cannula Oxygen Therapy Versus Conventional Oxygen Therapy in Patients With High-altitude Pulmonary Edema: A Prospective Randomized Controlled Study

TypeinterventionalSponsorThird Military Medical UniversityRan2026 to 2029Enrolled208ConditionsHigh-altitude Pulmonary EdemaArmsHigh-flow Nasal Cannula Oxygen Therapy (HFNC)
3 · Its place in the literature

Who cites it

239 citing papers in PubMed, 21 syntheses or guidelines pooled it, 395 citations in OpenAlex.

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179 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 14 institutions in 6 countries.

B RochwergMichael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada. rochwerg@mcmaster.ca.ORCID 0000-0002-8293-7061
D GrantonMichael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada.
D X WangSchulich School of Medicine, Western University, London, ON, Canada.
Y HelvizGeneral Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
S EinavGeneral Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
J P FratCHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
A Mekontso-DessapHôpitaux Universitaires Henri Mondor, Créteil, France.
A SchreiberDepartment of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada.
E AzoulayHôpital Saint-Louis, Paris, France.
A MercatDépartement de Médecine Intensive-Réanimation, CHU d'Angers, Université d'Angers, Angers, France.
A DemouleService de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.
V LemialeHôpital Saint-Louis, Paris, France.
A PesentiUniversità degli Studi di Milano, Dipartimento di Fisopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy.
E D RivielloDivision of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
T MauriUniversità degli Studi di Milano, Dipartimento di Fisopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy.
J ManceboServei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.
L BrochardInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
K BurnsInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Délégation Paris 7 · FRInserm · FRUniversity of Milan · ITUniversity of Toronto · CABeth Israel Deaconess Medical Center · USHebrew University of Jerusalem · ILHospital de Sant Pau · ESJuravinski Hospital · CAMcMaster University · CAShaare Zedek Medical Center · ILUniversité d'Angers · FRUniversité Paris Cité · FRUniversity Health Network · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThis systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure.

methodsWe performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods.

resultsWe included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use.

conclusionIn patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.

Indexed as

CannulaHumansHypoxiaOxygenOxygen Inhalation TherapyRespiratory InsufficiencyTreatment OutcomeOxygenHigh flow nasal cannulaMeta-analysisRespiratory failure

Identifiers

PMID30888444
OpenAlexW2923561136

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 3 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.