SynthesisFrontiers in medicine2026
High-flow nasal cannula versus noninvasive ventilation in acute heart failure-related respiratory failure: a systematic review and meta-analysis.
Synthesis in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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10 authors.
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Abstract
Background: Noninvasive ventilation (NIV) is the recommended first-line respiratory support for acute heart failure (AHF)-related respiratory failure. However, its tolerance is often limited. High-flow nasal cannula (HFNC) has emerged as a potential alternative, but comparative evidence remains inconsistent. This study aimed to evaluate the efficacy and safety of HFNC versus NIV in patients with AHF-related respiratory failure. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched four major electronic databases from inception to April 2026. We included randomized controlled trials (RCTs) and observational studies enrolling adult patients with respiratory failure secondary to AHF or acute cardiogenic pulmonary edema, comparing HFNC and NIV. The primary outcome was composite treatment failure. Secondary outcomes included endotracheal intubation, short-term mortality, arterial blood gas (ABG) parameters, respiratory rate, dyspnea scores, and hospital length of stay. A random-effects model was used. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Ten studies ( Conclusion: The available evidence did not find a statistically significant difference between HFNC and NIV in terms of clinical efficacy in patients with AHF-related respiratory failure. HFNC may be considered in selected patients who do not tolerate NIV, provided that close monitoring and prompt access to NIV escalation are available. Although the certainty of evidence was generally moderate for RCTs comparisons, further adequately powered multicenter RCTs are needed to better define patient selection and clinically important differences. Systematic review registration: www.crd.york.ac.uk/PROSPERO/view/CRD420261330512, identifier CRD420261330512.
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