Comparative Effectiveness of High-Flow Nasal Cannula Versus Non-Invasive Ventilation for Post-Extubation Respiratory Support After Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational Cohorts

High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) are commonly used for respiratory support after extubation in pediatric cardiac surgery. This study aimed to compare their clinical effectiveness and safety. A systematic review and meta-analysis of observational studies published from January 2015 to June 2025 was performed. Databases including PubMed, Scopus, Web of Science, and CINAHL were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Six observational studies with a total of 1,142 pediatric patients were included. The primary outcomes were re-intubation rate, escalation of respiratory support, intensive care unit (ICU) length of stay, and hospital length of stay. Data were pooled using random-effects models, and heterogeneity was assessed using the I² statistic. The meta-analysis indicated that HFNC was associated with similar or lower re-intubation rates compared with NIV (pooled odds ratio 0.82; 95% confidence interval, 0.61-1.08; p = 0.19; I² = 42%). Escalation of support occurred less frequently with HFNC in most studies. ICU and hospital stays were comparable or slightly shorter in the HFNC group, suggesting potential benefits in comfort and recovery. Risk of bias across included studies was generally low to moderate. The findings support the clinical equivalence of HFNC and NIV for post-extubation respiratory management in pediatric cardiac patients. This systematic review and meta-analysis suggest that high-flow nasal cannula may be a practical and effective alternative to non-invasive ventilation in this population. Further large multicenter studies are recommended to validate these results and evaluate long-term outcomes.