Background. Although the efficacy and safety of high-flow nasal cannula (HFNC) in hypoxemic respiratory failure are widely recognized, it is yet unclear whether HFNC can effectively reduce the intubation rate and mortality in hypercapnic respiratory failure. We performed a systematic review and meta-analysis to assess the safety and efficiency of HFNC in these patients. Methods. A systematic search of PubMed, Embase, and Cochrane Library (CENTRAL) was carried out. Two reviewers independently screened all references according to the inclusion criteria. We used the Cochrane risk-of-bias tool and the Newcastle–Ottawa Quality Assessment Scale to assess the quality of randomized controlled trials (RCTs) and cohort studies, respectively. Data from eligible trials were extracted for the meta-analysis. Results. Eight studies with a total of 621 participants were included (six RCTs and two cohort studies). Our analysis showed that HFNC is noninferior to noninvasive ventilation (NIV) with respect to intubation rate in both RCTs (OR = 0.92, 95% CI: 0.45–1.88) and cohort studies (OR = 0.94, 95% CI: 0.55–1.62). Similarly, the analysis of cohort studies showed no difference in reducing mortality rates (OR = 0.96, 95% CI: 0.42–2.20). Based on RCTs, NIV seemed more effective in reducing mortality (OR = 1.33, 95% CI: 0.68–2.60), but the intertreatment difference was not statistically significant. Furthermore, no significant differences were found between HFNC and NIV relating to change of blood gas analysis or respiratory rate (MD = −0.75, 95% CI: −2.6 to 1.09). Likewise, no significant intergroup differences were found with regard to intensive care unit stay (SMD = −0.07, 95% CI: 0.26 to 0.11). Due to a physiological friendly interface and variation, HFNC showed a significant advantage over NIV in patients’ comfort and complication of therapy. Conclusion. Despite the limitations noted, HFNC may be an effective and safe alternative to prevent endotracheal intubation and mortality when NIV is unsuitable in mild-to-moderate hypercapnia. Further high-quality studies are needed to validate these findings.

中文翻译：

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高碳酸血症呼吸衰竭的高流量鼻导管：系统评价和荟萃分析

背景。尽管高流量鼻导管（HFNC）治疗低氧性呼吸衰竭的有效性和安全性得到广泛认可，但HFNC能否有效降低高碳酸血症呼吸衰竭的插管率和死亡率尚不清楚。我们进行了系统回顾和荟萃分析，以评估 HFNC 在这些患者中的安全性和有效性。方法。对 PubMed、Embase 和 Cochrane 图书馆 (CENTRAL) 进行了系统搜索。两名审稿人根据纳入标准独立筛选所有参考文献。我们分别使用 Cochrane 偏倚风险工具和纽卡斯尔-渥太华质量评估量表来评估随机对照试验 (RCT) 和队列研究的质量。从符合条件的试验中提取数据用于荟萃分析。结果. 包括八项研究，共有 621 名参与者（六项 RCT 和两项队列研究）。我们的分析表明，在 RCT（OR = 0.92，95% CI：0.45-1.88）和队列研究（OR = 0.94，95% CI：0.55-1.62）中，HFNC 在插管率方面不劣于无创通气（NIV） . 同样，队列研究的分析显示降低死亡率没有差异（OR = 0.96，95% CI：0.42–2.20）。根据 RCT，NIV 似乎在降低死亡率方面更有效（OR = 1.33，95% CI：0.68-2.60），但治疗间差异无统计学意义。此外，在血气分析或呼吸频率变化方面，HFNC 和 NIV 之间没有发现显着差异（MD = -0.75，95% CI：-2.6 至 1.09）。同样地，在重症监护病房住院时间方面没有发现显着的组间差异（SMD = -0.07，95% CI：0.26 至 0.11）。由于生理友好的界面和变化，HFNC 在患者的舒适度和治疗并发症方面表现出优于 NIV 的显着优势。结论。尽管存在局限性，但当 NIV 不适用于轻至中度高碳酸血症时，HFNC 可能是预防气管插管和死亡的有效且安全的替代方法。需要进一步的高质量研究来验证这些发现。