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The following is a summary of “High-flow nasal cannula oxygen therapy versus noninvasive ventilation in acute respiratory failure related to suspected or confirmed acute heart failure: a systematic review with meta-analysis,” published in the December 2024 issue of Emergency Medicine by Marjanovic et al.
Researchers conducted a retrospective study to compare high-flow nasal cannula (HFNC) oxygen and noninvasive ventilation (NIV) for managing acute respiratory failure secondary to suspected or confirmed acute heart failure (AHF).
They searched literature across MEDLINE, Web of Science, and the Cochrane Library by Medical Subject Heading and free text terms from January 2010 to March 2024 with randomized clinical trials and observational studies (both retrospective and prospective) involving individuals with acute respiratory failure because of suspected or confirmed AHF, comparing HFNC oxygen with NIV. The primary outcome included treatment failure, defined as early termination of allocated treatment, need for in-hospital intubation, or mortality, or as per the study’s definition if adequate. Secondary outcomes assessed changes in respiratory rate, dyspnea intensity post-treatment initiation, patient comfort, need for invasive mechanical ventilation, and day-30 mortality.
The results showed 6 of 802 identified studies were included in the final analysis, with 572 patients (221 assigned to high-flow oxygen and 351 to NIV). Treatment failure occurred in 20% and 13% of the high-flow oxygen and NIV groups, respectively (OR: 1.7, 95% CI: 0.9–3.1) in randomized studies, and 34% and 16% in the high-flow oxygen and NIV groups, respectively (OR: 3.1, 95% CI: 0.7–13.5). Tracheal intubation was required in 5% and 7% of patients in the NIV and HFNC groups, respectively (OR: 1.4, 95% CI: 0.5–3.5) in randomized studies, and 20% and 9% in the high-flow oxygen and NIV groups, respectively (OR: 2.1, 95% CI: 0.5–9.4) in observational studies. Mortality was 13% and 8% in the high-flow oxygen and NIV groups, respectively (OR: 1.8, 95% CI: 0.8–1.1) in randomized studies, and 9% and 14%in the NIV groups and high-flow oxygen, respectively (OR: 1.4, 95% CI: 0.5–3.7) in observational studies.
Investigators concluded the HFNC oxygen therapy did not demonstrate a higher risk of treatment failure compared to NIV in the initial management of patients with acute respiratory failure suspected or confirmed to be due to AHF.
