• Lili Guan, Jianyi Niu, Qiaoyun Huang, Shanshan Zha, Zhenfeng He, Jieying Hu, Shengchuan Feng, Luqian Zhou, and Rongchang Chen.
• Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
• Eur. J. Intern. Med. 2025 Feb 8.

BackgroundNoninvasive ventilation (NIV) is recommended as the first-line respiratory support method for patients with hypercapnic respiratory failure (HRF). However, the need for well-trained operators and the occurrence of treatment discomfort may limit its efficacy. High-flow nasal oxygen therapy (HFNO) is a convenient respiratory support with user-friendly operation, high comfort, and good compliance. This systematic review and meta-analysis was performed to compare the therapeutic effects of HFNO and other noninvasive respiratory support methods [NIV or conventional oxygen therapy (COT)] in patients with acute HRF (AHRF) or chronic HRF (CHRF).MethodsWe searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to May 2024 to identify randomized clinical trials comparing the impact of HFNO and NIV/COT in adults with HRF.ResultsSixteen studies (1630 patients) were included. Compared with NIV, HFNO did not improve the primary outcome of PaCO2 in patients with AHRF or CHRF [AHRF: MD = -0.81, 95 % CI = -3.40 to 1.77; CHRF: MD = 1.82, 95 % CI = 0.44 to 3.20]. However, HFNO showed advantages over COT (AHRF: MD = -2.03, 95 % CI = -3.48 to -0.59; CHRF: MD = -2.64, 95 % CI = -4.24 to -1.03).ConclusionsThe evidence of its clinical efficacy in hypercapnic patients remains inconclusive. Further studies are needed to generate more evidence for the application of HFNO in patients with HRF and to determine the subset of patients for whom may be preferable.Copyright © 2025. Published by Elsevier B.V.

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