• Thalia Monro-Somerville, Malcolm Sim, James Ruddy, Mark Vilas, and Michael A Gillies.
• 1Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.2Department of Anaesthesia, Critical Care and Pain Medicine, Queen Elizabeth University Hospital, Glasgow, United Kingdom.3Department of Anaesthesia, Critical Care and Pain Medicine, Monklands General Hospital, Airdrie, United Kingdom.
• Crit. Care Med. 2017 Apr 1; 45 (4): e449-e456.

ObjectiveHigh-flow nasal cannulae are used in adults with or at risk of acute respiratory failure. We conducted a systematic review and meta-analysis to evaluate the evidence for their use in this setting.Data SourcesOvid Medline, Embase, and Cochrane Database of Systematic Reviews.Study SelectionDatabases were searched for randomized controlled trials comparing administration of high-flow nasal cannulae with usual care (i.e., conventional oxygen therapy or noninvasive ventilation) in adults with respiratory failure. The primary outcome was hospital mortality; the rate of intubation and assessment of delirium and comfort were secondary outcomes.Data ExtractionOne hundred forty-seven nonduplicate citations were screened, 32 underwent full screening and data extraction, and 14 trials were eligible for inclusion in the review. Nine trials were used in the meta-analysis, including a total of 2,507 subjects.Data SynthesisWhen high-flow nasal cannulae were compared with usual care, there was no difference in mortality (high-flow nasal cannulae, 60/1,006 [6%] vs usual care, 90/1,106 [8.1%]) (n = 2,112; p = 0.29; I, 25%; fixed effect model: odds ratio, 0.83; 95% CI, 0.58-1.17) or rate of intubation (high-flow nasal cannulae, 119/1,207 [9.9%] vs usual care, 204/1,300 [15.7%]) (n = 2,507; p = 0.08; I, 53%; random effect model: odds ratio, 0.63; 95% CI, 0.37-1.06). A qualitative analysis of 13 studies on tolerability and comfort suggested that high-flow nasal cannulae are associated with improved patient comfort and dyspnea scores. Trial sequential analyses on primary and secondary outcomes suggested that required information size was not reached.ConclusionsNo difference in mortality or intubation was detected in patients with acute respiratory failure treated with high-flow nasal cannulae compared with usual care. High-flow nasal cannulae seem well tolerated by patients. Further large randomized controlled trials are required to evaluate their utility in this setting.

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