High-flow nasal cannula compared with conventional oxygen therapy or noninvasive ventilation immediately postextubation: A systematic review and meta-analysis

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, Karen E.A. Burns, Bram Rochwerg

Research output: Contribution to journalReview ArticleResearchpeer-review

13 Citations (Scopus)


Objectives: Reintubation 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 Sources: We searched MEDLINE, EMBASE, and Web of Science. Study Selection: We included randomized controlled trials comparing high-flow nasal cannula to other noninvasive methods of oxygen delivery after extubation in critically ill adults. Data Extraction: We included the following outcomes: reintubation, postextubation respiratory failure, mortality, use of noninvasive ventilation, ICU and hospital length of stay, complications, and comfort. Data Synthesis: We 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. Conclusions: High-flow nasal cannula reduces reintubation compared with conventional oxygen therapy, but not compared with noninvasive ventilation after extubation.

Original languageEnglish
Pages (from-to)e1129-e1136
Number of pages8
JournalCritical Care Medicine
Issue number11
Publication statusPublished - Nov 2020


  • High-flow nasal cannula
  • Meta-analysis
  • Noninvasive ventilation
  • Oxygen inhalational therapy
  • Postextubation
  • Reintubation

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