Moderate certainty evidence suggests the use of high-flow nasal cannula does not decrease hypoxia when compared with conventional oxygen therapy in the peri-intubation period: Results of a systematic review and meta-analysis

Dipayan Chaudhuri, David Granton, Dominic Xiang Wang, Sharon Einav, Yigal Helviz, Tommaso Mauri, Jean Damien Ricard, Jordi Mancebo, Jean Pierre Frat, Sameer Jog, Gonzalo Hernandez, Salvatore M. Maggiore, Carol Hodgson, Samir Jaber, Laurent Brochard, Karen E.A. Burns, Bram Rochwerg

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28 Citations (Scopus)


Objective: The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and metaanalysis examining the benefits of high-flow nasal cannula in the peri-intubation period. Data Sources: We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science). Study Selection: We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period. Data Extraction: Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, Pao2 before and after intubation, Paco2 after intubation, ICU length of stay, and short-term mortality. Data Synthesis: We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68-1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71-1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), Pao2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation Paco2, ICU length of stay, or 28-day mortality. Conclusions: We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intu- bation period when compared with conventional oxygen therapy.

Original languageEnglish
Pages (from-to)571-578
Number of pages8
JournalCritical Care Medicine
Issue number4
Publication statusPublished - Apr 2020


  • Artificial respiration
  • Hypoxia
  • Intubation
  • Noninvasive ventilation
  • Oxygen inhalation therapy
  • Systematic review

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