High-flow nasal cannula for acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis

• Published in: Heart & lung Vol. 50; no. 2; pp. 252 - 261
• Main Authors: Yang, Peng-Lei, Yu, Jiang-Quan, Chen, Han-Bing
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021
• Subjects: Cannula; Chronic obstructive pulmonary disease; Humans; Meta-analysis; Non-invasive ventilation; Noninvasive Ventilation; Observational Studies as Topic; Oxygen Inhalation Therapy; Oxygen therapy; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - therapy; Respiratory Insufficiency - therapy; Chronic obstructive pulmonary disease; Oxygen therapy; Non-invasive ventilation; Meta-analysis
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2020.12.010

·This meta-analysis showed that HFNC may not increase the risk of intubation or mortality compared to NIV, HFNC may not exacerbate hypercapnia and acidosis in AECOPD patients with hypercapnia and mild acidosis and patients weaned from invasive ventilation.·Compared to COT, HFNC may also not exacerbate hypercapnia and acidosis, but decrease the respiratory rate and diaphragm movement for patients with hypoxemia and patients with mild hypercapnia. The evidence for the safety of high-flow nasal cannula (HFNC) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients is conflicting. To evaluate the intubation and mortality risks of HFNC compared to non-invasive ventilation (NIV) and conventional oxygen therapy (COT) for AECOPD patients. A search of electronic databases was performed. Studies that used HFNC to treat AECOPD patients were identified. Seven RCTs and one observational study were included. There were no differences in intubation risk (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.49 to 1.78, p = 0.84, very low certainty) and mortality risk (RR 0.91, 95% CI 0.46 to 1.79, p = 0.77, very low certainty) for HFNC compared with NIV. No data were available for intubation or mortality risk for HFNC compared with COT. For AECOPD patients, low-quality evidence indicates that HFNC does not increase intubation and mortality risks compared to NIV.