The effect of high flow nasal oxygen therapy in intensive care units: a systematic review and meta-analysis

Background High flow nasal oxygen (HFNO) therapy has been widely used in intensive care units (ICU); however, its efficacy remains inconclusive. This systematic review and meta-analysis aimed to compare the efficacy of HFNO therapy with th at of alternative noninvasive oxygen therapies such as conventional oxygen therapy (COT) and noninvasive ventilation (NIV) in ICU. Methods A Pubmed, Embase, Web of Science, Cochrane Library database search was performed in March 2020. Results: The meta-analysis ultimately included 17 clinical studies. Compared with the overall effect of COT and NIV, HFNO was associated with a low incidence of pneumonia (95% CI: 0.6-0.99, P = 0.04) and improvement in lowest pulse oxygen saturation (SpO) during oxygenation (95% CI: 0.02-1.61; P = 0.04). However, no differences were detected in the following outcomes: length of ICU stay, the rate of intubation or reintubation, mortality at day 28, hospital mortality, and SpO(2) at the end of oxygen therapy (all P > 0.05). Conclusions In adult patients in ICU, HFNO may improve oxygenation and decrease pneumonia rate without affecting the length of ICU stay, intubation or reintubation rate, mortality, and SpO(2) at the end of oxygen therapy.