High-Flow Nasal Cannula Compared With Conventional Oxygen Therapy or Noninvasive Ventilation Immediately Postextubation: A Systematic Review and Meta-Analysis Journal Articles uri icon

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  • Objectives: Reintubation after failed extubation is associated with increased mortality and longer hospital length of stay. Noninvasive oxygenation modalities may prevent reintubation. We conducted a systematic review and meta-analysis to determine the safety and efficacy of high-flow nasal cannula after extubation in critically ill adults. Data Sources: We searched MEDLINE, EMBASE, and Web of Science. Study Selection: We included randomized controlled trials comparing high-flow nasal cannula to other noninvasive methods of oxygen delivery after extubation in critically ill adults. Data Extraction: We included the following outcomes: reintubation, postextubation respiratory failure, mortality, use of noninvasive ventilation, ICU and hospital length of stay, complications, and comfort. Data Synthesis: We included eight randomized controlled trials (n = 1,594 patients). Compared with conventional oxygen therapy, high-flow nasal cannula decreased reintubation (relative risk, 0.46; 95% CI, 0.30–0.70; moderate certainty) and postextubation respiratory failure (relative risk, 0.52; 95% CI, 0.30–0.91; very low certainty), but had no effect on mortality (relative risk, 0.93; 95% CI, 0.57–1.52; moderate certainty), or ICU length of stay (mean difference, 0.05 d fewer; 95% CI, 0.83 d fewer to 0.73 d more; high certainty). High-flow nasal cannula may decrease use of noninvasive ventilation (relative risk, 0.64; 95% CI, 0.34–1.22; moderate certainty) and hospital length of stay (mean difference, 0.98 d fewer; 95% CI, 2.16 d fewer to 0.21 d more; moderate certainty) compared with conventional oxygen therapy, however, certainty was limited by imprecision. Compared with noninvasive ventilation, high-flow nasal cannula had no effect on reintubation (relative risk, 1.16; 95% CI, 0.86–1.57; low certainty), mortality (relative risk, 1.12; 95% CI, 0.82–1.53; moderate certainty), or postextubation respiratory failure (relative risk, 0.82; 95% CI, 0.48–1.41; very low certainty). High-flow nasal cannula may reduce ICU length of stay (moderate certainty) and hospital length of stay (moderate certainty) compared with noninvasive ventilation. Conclusions: High-flow nasal cannula reduces reintubation compared with conventional oxygen therapy, but not compared with noninvasive ventilation after extubation.


  • Granton, David
  • Chaudhuri, Dipayan
  • Wang, Dominic
  • Einav, Sharon
  • Helviz, Yigal
  • Mauri, Tommaso
  • Mancebo, Jordi
  • Frat, Jean-Pierre
  • Jog, Sameer
  • Hernandez, Gonzalo
  • Maggiore, Salvatore M
  • Hodgson, Carol L
  • Jaber, Samir
  • Brochard, Laurent
  • Trivedi, Vatsal
  • Ricard, Jean-Damien
  • Goligher, Ewan C
  • Burns, Karen EA
  • Rochwerg, Bram

publication date

  • November 2020