• David Granton, Dipayan Chaudhuri, Dominic Wang, Sharon Einav, Yigal Helviz, Tommaso Mauri, Jordi Mancebo, Jean-Pierre Frat, Sameer Jog, Gonzalo Hernandez, Salvatore M Maggiore, Carol L Hodgson, Samir Jaber, Laurent Brochard, Vatsal Trivedi, Jean-Damien Ricard, Ewan C Goligher, BurnsKaren E AKEAInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada., and Bram Rochwerg.
• Department of Medicine, McMaster University, Hamilton, ON, Canada.
• Crit. Care Med. 2020 Nov 1; 48 (11): e1129-e1136.

ObjectivesReintubation after failed extubation is associated with increased mortality and longer hospital length of stay. Noninvasive oxygenation modalities may prevent reintubation. We conducted a systematic review and meta-analysis to determine the safety and efficacy of high-flow nasal cannula after extubation in critically ill adults.Data SourcesWe searched MEDLINE, EMBASE, and Web of Science.Study SelectionWe included randomized controlled trials comparing high-flow nasal cannula to other noninvasive methods of oxygen delivery after extubation in critically ill adults.Data ExtractionWe included the following outcomes: reintubation, postextubation respiratory failure, mortality, use of noninvasive ventilation, ICU and hospital length of stay, complications, and comfort.Data SynthesisWe included eight randomized controlled trials (n = 1,594 patients). Compared with conventional oxygen therapy, high-flow nasal cannula decreased reintubation (relative risk, 0.46; 95% CI, 0.30-0.70; moderate certainty) and postextubation respiratory failure (relative risk, 0.52; 95% CI, 0.30-0.91; very low certainty), but had no effect on mortality (relative risk, 0.93; 95% CI, 0.57-1.52; moderate certainty), or ICU length of stay (mean difference, 0.05 d fewer; 95% CI, 0.83 d fewer to 0.73 d more; high certainty). High-flow nasal cannula may decrease use of noninvasive ventilation (relative risk, 0.64; 95% CI, 0.34-1.22; moderate certainty) and hospital length of stay (mean difference, 0.98 d fewer; 95% CI, 2.16 d fewer to 0.21 d more; moderate certainty) compared with conventional oxygen therapy, however, certainty was limited by imprecision. Compared with noninvasive ventilation, high-flow nasal cannula had no effect on reintubation (relative risk, 1.16; 95% CI, 0.86-1.57; low certainty), mortality (relative risk, 1.12; 95% CI, 0.82-1.53; moderate certainty), or postextubation respiratory failure (relative risk, 0.82; 95% CI, 0.48-1.41; very low certainty). High-flow nasal cannula may reduce ICU length of stay (moderate certainty) and hospital length of stay (moderate certainty) compared with noninvasive ventilation.ConclusionsHigh-flow nasal cannula reduces reintubation compared with conventional oxygen therapy, but not compared with noninvasive ventilation after extubation.

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