High flow nasal cannula efficiency for critically ill patients (multiple reviews)
What is this? Some patients with COVID-19 may require oxygen support, including the use of high-flow nasal cannula for high flows of blended humidified air and oxygen. Multiple potentially relevant systematic reviews have been done and some of these are used for this summary. More details on these reviews, including citations and links to their full text, are available further down this page.
What was found: The Corley systematic review found insufficient evidence to determine the effects of high-flow nasal cannula compared with other forms of respiratory support for adult patients in intensive care units.
At the time of their rapid review, Agarwal et al. reported that high-flow nasal cannula may reduce the need for invasive ventilation and escalation of therapy when compared with conventional oxygen therapy in patients with acute hypoxemic respiratory failure. However, the relevance of the findings to COVID-19 patients is uncertain because none of the patients in the included studies had COVID-19.
At the time of their rapid review, Agarwal et al. reported that the evidence on droplet dispersion and aerosol generation and dispersion was of very low certainty.
What are the reviews:
Citation: Agarwal A, Basmaji J, Muttalib F, et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2020;67:1217-48.
In these two systematic reviews commissioned by WHO, the authors searched for randomized trials comparing high-flow nasal cannula to conventional oxygen therapy in critically ill patients with acute hypoxemic respiratory failure, and studies evaluating droplet dispersion, aerosol generation, or infection transmission associated with high-flow nasal cannula. They did not restrict by language of publication but restricted their searches to articles published between 1 January 2007 and 14 May 2020. They included 12 randomized trials (total: 1,989 participants) for the review of acute hypoxemic respiratory failure and 7 studies for the review on aerosol generation.
Citation: Corley A, Rickard CM, Aitken LM, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database of Systematic Reviews 2017;(5):CD010172.
In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials of high-flow nasal cannula in adult patients in intensive care units. They did not restrict their searches by language of publication but searched for articles published since 2000 in March 2016. They included 11 studies (total: 1972 participants) and identified a further 4 studies in a search in December 2016, which will be considered in an update to the review.
Other reviews of similar topics
Citation: Barbateskovic M, Schjørring OL, Russo Krauss S, et al. Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit. Cochrane Database of Systematic Reviews 2019;(11):CD012631.
Citation: Zhang Y, Fang C, Br D, et al. Oxygen therapy for pneumonia in adults. Cochrane Database for Systematic Reviews. 2012;(3):CD006607