Comparison of the efficacy and comfort of high-flow nasal cannula with different initial flow settings in patients with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

He, Yuewen; Zhuang, Xuhui; Liu, Hao; Ma, Wuhua

doi:10.1186/s40560-023-00667-2

Journal of Intensive Care

Table 2 The intervention’s characteristics of included studies (n = 23)

From: Comparison of the efficacy and comfort of high-flow nasal cannula with different initial flow settings in patients with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

Authors, nationality	Definition of AHRF	Groups	Initial flow settings	Oxygenation strategy	Oxygen therapy apparatus
Alptekinoğlu et al. 2021 Turkey	PaO₂/FiO₂ ratio < 300 mmHg or SpO₂ < 92% on room air, PaCO₂ ≤ 45 mmHg, RR > 22 breaths/min, or labored breathing with respiratory distress	HFNC	30 L/min	Temperature: NR Maximal flow rate: 50 L/min FiO₂: 100% SpO₂: ≥ 94% Duration of treatment: NR	NR
Alptekinoğlu et al. 2021 Turkey		NIV	6 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: ≥ 94% Duration of treatment: NR	Nasal prongs or facial oxygen masks without reservoir bag
Andino et al. 2020 Spanish	PaO₂/FiO₂ ratio ≤ 200 mmHg or SpO₂/FiO₂ ratio ≤ 160 mmHg and RR > 30 breaths/ min for at least 30 min	HFNC	20 L/min	Temperature: 34–37 °C Maximal flow rate: 50 L/min FiO₂: 60%-100% SpO₂: ≥ 93% Duration of treatment: NR	Optiflow®, Fisher & Paykel, Maidenhead, UK
Andino et al. 2020 Spanish		NIV	15 L/min	Temperature: NR Maximal flow rate: 30 L/min FiO₂: 60%-100% SpO₂: ≥ 93% Duration of treatment: NR	Venturi mask
Azoulay et al. 2018 France	AHRF with PaO₂ < 60 mm Hg or SpO₂ < 90% on room air, or tachypnea > 30/min or labored breathing or respiratory distress; FiO₂ ≥ 6 L/min	HFNC	50 L/min	Temperature: NR Maximal flow rate: 60 L/min FiO₂: 100% SpO₂: ≥ 95% Duration of treatment: NR	NR
Azoulay et al. 2018 France		NIV	NR	Temperature: NR Maximal flow rate: 15 L/min FiO₂: 100% SpO₂: ≥ 95% Duration of treatment: NR	Any device or combination of devices used for standard care (nasal prongs or mask with or without a reservoir bag and with or without a Venturi system)
Bell et al. 2015 Australia	RR > 25 breaths/min and SpO₂ < 93%	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 30% SpO₂: NR Duration of treatment: ≥ 2 h	AIRVO2, Optiflow, Fisher & Paykel, Auckland, New Zealand
Bell et al. 2015 Australia	RR > 25 breaths/min and SpO₂ < 93%	NIV	NR	Temperature: NR Maximal flow rate: 60 L/min FiO₂: 100% SpO₂: NR Duration of treatment: ≥ 2 h	Standard nasal prongs or face mask (Hudson, venturi system or non- rebreather)
Coudroy et al. 2022 France	RR ≥ 25 breaths /min, and PaO₂/FiO₂ ratio ≤ 300 mm Hg	HFNC	60L/min	Temperature: NR Maximal flow rate: NR FiO₂:NR SpO₂: ≥ 92% Duration of treatment: NR	Heated humidifier (MR 850, Fisher & Paykel Healthcare, Auckland, New Zealand)
Coudroy et al. 2022 France	RR ≥ 25 breaths /min, and PaO₂/FiO₂ ratio ≤ 300 mm Hg	NIV	VT ≤ 8 ml/kg PEEP > 8 cmH₂O	Temperature: NR Maximal flow rate: NR FiO₂:NR SpO₂: ≥ 92% Duration of treatment: NR	ICU ventilator after activation of non-invasive mode or non-invasive bilevel ventilator
Feng et al. 2020 China	RR ≥ 25 breaths/min, PaO₂/FiO₂ ratio ≤ 300 mmHg, and PaCO₂ ≤ 45 mmHg	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: ≥ 93% Duration of treatment: ≥ 2d	Fisher and Paykel Healthcare
		SO	> 10 L/min	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 93% Duration of treatment: ≥ 2d	Mask
		NIV	VT = 7–10 ml/kg, PEEP = 2–10 cmH₂O	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 93% Duration of treatment: ≥ 2d	Respironics BiPAP non-invasive ventilator
Frat et al. 2015 France	RR ≥ 25 breaths/min, PaO₂/FiO₂ ratio ≤ 300 mmHg while breathing oxygen ≥ 10 L/min for at least 15 min, PaCO₂ ≤ 45 mmHg	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 1.0 SpO₂: ≥ 92% Duration of treatment: ≥ 2d	Heated humidifier (MR850, Fisher and Paykel Healthcare)
		SO	≥ 10 L/min	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 92% Duration of treatment: NR	Nonrebreather face mask
		NIV	VT = 7–10 ml/kg, PEEP = 2–10 cmH₂O	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 92% Duration of treatment: ≥ 2d	Face mask (Fisher and Paykel Health- care)
Frat et al. 2022 France	PaO₂/FiO₂ ratio ≤ 200 mmHg while breathing oxygen at a flow rate of 10 L/min or more for at least 15 min	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: 92–96% Duration of treatment: ≥ 48 h	Optiflow or Airvo-2, Fisher & Paykel Healthcare; or an ICU ventilator with a high-flow oxygen therapy option
Frat et al. 2022 France		NIV	10L/min	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: 92%—96% Duration of treatment: ≥ 48 h	Nonrebreathing mask
Grieco et al. 2021 Italy	PaO₂/FiO₂ ratio ≤ 200 mmHg, PaCO₂ ≤ 45 mmHg	HFNC	60 L/min	Temperature: 34 °C or 37 °C Maximal flow rate: 60 L/min FiO₂: NR SpO₂: 92%—98% Duration of treatment: ≥ 48 h	Fisher and Paykel Healthcare, New Zealand
Grieco et al. 2021 Italy	PaO₂/FiO₂ ratio ≤ 200 mmHg, PaCO₂ ≤ 45 mmHg	NIV	NR	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: 92%—98% Duration of treatment: 48 h	Helmet interface (Dimar, Italy, or Starmed-Intersurgical, UK)
Jones et al. 2016 New Zealand	SpO₂ < 92% on air, RR ≥ 22 breaths/min	HFNC	40 L/min	Temperature: 37 °C Maximal flow rate: NR FiO₂: 28% SpO₂: 93% Duration of treatment: NR	Optiflow nasal interface connected to the PT101AX (Airvo1) or PT101AZ (Airvo2) humidifier (Fisher & Paykel Healthcare, Auckland, New Zealand)
Jones et al. 2016 New Zealand	SpO₂ < 92% on air, RR ≥ 22 breaths/min	NIV	1–15 L/min	Temperature: NR Maximal flow rate: 15L/min FiO₂: NR SpO₂: 93% Duration of treatment: NR	HudNIVn mask, Venturi device, or standard nasal prongs
Lemiale et al. 2015 France	FiO₂ > 6 L/min to maintain SpO₂ > 95% or symptoms of respiratory distress (tachypnea > 30/min, intercostal recession, labored breathing, and/or dyspnea at rest)	HFNC	40–50 L/min	Temperature: NR Maximal flow rate: 50 L/min FiO₂: 100% SpO₂: ≥ 95% Duration of treatment: ≥ 2 h	Heated humidified circuit
Lemiale et al. 2015 France		NIV	15 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 60% SpO₂: ≥ 95% Duration of treatment: ≥ 2 h	Venturi mask
Lemiale et al. 2016 France	FiO₂ > 6 L/min to maintain SpO₂ > 95% or symptoms of respiratory distress (tachypnea > 30/min, intercostal recession, labored breathing, and/or dyspnea at rest)	HFNC	Median (Range): 40 (15–50) L/min	Temperature: NR Maximal flow rate: 50 L/min FiO₂: NR SpO₂: 92% Duration of treatment: NR	NR
Lemiale et al. 2016 France		NIV	Median (Range): 5 (4–9) L/min	Temperature: NR Maximal flow rate: 9 L/min FiO₂: NR SpO₂: NR Duration of treatment: NR	NR
Liu et al. 2018 China	RR ≥ 30 breaths/min, PaO₂/FiO₂ ratio < 200 mmHg	HFNC	45 L/min	Temperature: 37 °C Maximal flow rate: NR FiO₂: 60%-80% SpO₂: NR Duration of treatment: NR	Fisher & Paykel's high-flow transnasal oxygenation devices and nasal plug catheters
Liu et al. 2018 China	RR ≥ 30 breaths/min, PaO₂/FiO₂ ratio < 200 mmHg	NIV	NR	Temperature: NR Maximal flow rate: NR FiO₂: 60%-80% SpO₂: NR Duration of treatment: NR	Phillip Non-invasive Ventilator V60
Nair et al. 2021 India	RR > 24 breaths/min and/or SpO₂ < 94%	HFNC	50 L/min	Temperature: NR Maximal flow rate: 60 L/min FiO₂: 1.0 SpO₂: ≥ 94% Duration of treatment: NR	Large-bore binasal prongs with a high-flow heated humidifier device (Optiflow, Fisher & Paykel Healthcare, Auckland, New Zealand)
Nair et al. 2021 India	RR > 24 breaths/min and/or SpO₂ < 94%	NIV	VT = 7–10 mL/kg PEEP = 5–10 cmH₂O	Temperature: NR Maximal flow rate: NR FiO₂: 0.5—1.0 SpO₂: ≥ 94% Duration of treatment: NR	Mask/helmet
OspinaTascón et al. 2021 Colombia	PaO₂/FiO₂ ratio ≤ 200 mmHg, and respiratory distress (use of accessory muscles and RR > 25/min)	HFNC	60 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: ≥ 92% Duration of treatment: NR	Large-bore binasal prongs using heated and humidified gas
OspinaTascón et al. 2021 Colombia		NIV	NR	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 92% Duration of treatment: NR	Nasal prongs, mask with or without oxy- gen reservoir, Venturi mask systems
Perkins et al. 2022 UK	SpO₂ ≤ 94% when FiO₂ ≥ 0.40	HFNC	Mean (95% CI): 52.4 (51.4–53.5) L/min	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: NR Duration of treatment: 3.7 (4.1) d	Heated humidified HFNC
Perkins et al. 2022 UK	SpO₂ ≤ 94% when FiO₂ ≥ 0.40	NIV	NR	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: NR Duration of treatment: 3.5 (4.6) d	Standard face mask or low-flow nasal cannula
Qiao et al. 2021 China	PaO₂ < 60 mmHg and PaCO₂ < 50 mmHg	HFNC	2–60 L/min	Temperature: 31–37 °C Maximal flow rate: 60 L/min FiO₂: 21%-100% SpO₂: > 94% Duration of treatment: NR	Fisher & Paykel Respiratory Humidifier (AIRVO2, manufactured by Fishser & Paykel, New Zealand)
Qiao et al. 2021 China	PaO₂ < 60 mmHg and PaCO₂ < 50 mmHg	NIV	NR	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: > 94% Duration of treatment: NR	Oxygen via nasal / face mask
Rittayamai et al. 2015 Thailand	RR > 24 breaths/min and SpO₂ < 94% on the room air	HFNC	35L/min	Temperature: 37 °C Maximal flow rate: 60L/min FiO₂: NR SpO₂: ≥ 94% Duration of treatment: NR	Optiflow, Fisher & Paykel Healthcare, Auckland, New Zealand
Rittayamai et al. 2015 Thailand	RR > 24 breaths/min and SpO₂ < 94% on the room air	NIV	3-10L/min	Temperature: 37 °C Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 94% Duration of treatment: NR	Nasal cannula or non-rebreathing mask
Stephan et al. 2015 France	PaO₂/FiO₂ ratio < 300 mmHg, RR > 25 breaths/min for at least 2 h	HFNC	50 L/min	Temperature: 37 °C Maximal flow rate: NR FiO₂: 50% SpO₂: 92%—98% Duration of treatment: NR	Nasal cannula with Optiflow (Fisher and Paykel Healthcare)
Stephan et al. 2015 France		NIV	VT = 9 ml/kg PEEP = 4 cmH₂O PS = 8 cmH₂O	Temperature: NR Maximal flow rate: NR FiO₂: 50% SpO₂: 92%—98% Duration of treatment: NR	Full-face mask
Vourc'h et al. 2019 France	Severe hypoxemia defined as SpO₂ < 96% with Venturi mask with FiO₂ of 50%	HFNC	45 L/min	Temperature: 37 ̊C Maximal flow rate: NR FiO₂: 100% SpO₂: NR Duration of treatment: 48 h	(Optiflow, Fisher & Paykel Healthcare, Auckland, New Zealand)
Vourc'h et al. 2019 France		NIV	15 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: NR Duration of treatment: 48 h	Hudson RCI non-rebreather mask with a reservoir bag
Wang et al. 2018 China	PaO₂ < 60 mmHg, RR > 25 breaths/min, PaO₂/FiO₂ ratio ≤ 200 mmHg, PaCO₂ < 45 mmHg	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: ≥ 92% Duration of treatment: NR	High-flow ventilator (Fisher & Paykel New Zealand, Airvo2)
Wang et al. 2018 China		NIV	5–10 L/min	Temperature: NR Maximal flow rate: 10L/min FiO₂: NR SpO₂: ≥ 92% Duration of treatment: NR	Nose and mouth mask, non-invasive ventilator
Zhao et al. 2019 China	PaO₂ < 60 mmHg, RR > 25 breaths/min, PaO₂/FiO₂ ratio ≤ 200 mmHg, PaCO₂ < 45 mmHg	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: ≥ 92% Duration of treatment: 48 h	Airvo2 Heated Humidified High Flow Dual Chamber Nasal Oxygenator (Fisher & Paykel, New Zealand)
Zhao et al. 2019 China		NIV	5–10 L/min	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 92% Duration of treatment: 48 h	Non-invasive ventilator V60 with oral and nasal mask (Philips Respironics, The Netherlands)
Zeng et al. 2019 China	RR ≥ 25 breaths/min, PaO₂/FiO₂ ratio ≤ 200 mmHg	HFNC	50 L/min	Temperature: NR Maximal flow rate: NR FiO₂: 100% SpO₂: ≥ 92% Duration of treatment: ≥ 48 h	Fisher and paykel healthcare
Zeng et al. 2019 China	RR ≥ 25 breaths/min, PaO₂/FiO₂ ratio ≤ 200 mmHg	NIV	VT = 6–10 mL/kg PEEP > 2 cmH₂O	Temperature: NR Maximal flow rate: NR FiO₂: NR SpO₂: ≥ 92% Duration of treatment: ≥ 48 h	PHILIPS V60 ventilator

HFNC high-flow nasal cannula, NIV non-invasive ventilation, ARDS acute respiratory distress syndrome, PaO₂/FiO₂ ratio ratio of arterial oxygen partial pressure to fractional inspired oxygen, PaCO₂ partial pressure of arterial carbon dioxide, SpO₂ oxygen saturation by pulse oximetry, RR respiratory rate, VT tidal volume, PEEP positive end-expiratory pressure, CI confidence interval, NR not recorded

Back to article page

ISSN: 2052-0492

Contact us

Submission enquiries: Access here and click Contact Us
General enquiries: info@biomedcentral.com