High‐Flow Nasal Cannula Versus Noninvasive Ventilation in the Treatment of Hypercapnic Respiratory Failure: Meta‐Analysis of Randomized Controlled Trials

ABSTRACT Aim To evaluate efficacy and safety of high‐flow nasal cannula (HFNC) versus noninvasive ventilation (NIV) in adults with hypercapnic respiratory failure (HRF). Methods We conducted a meta‐analysis of randomized controlled trials from PubMed, Embase, The Cochrane Library, Wanfang, CNKI, and Weipu comparing HFNC with NIV in HRF patients. Primary outcomes were mortality and endotracheal intubation. Secondary outcomes included blood gas values, hospital/ intensive care unit (ICU) length of stay, nasal skin breakdown, and comfort. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated. Results Twenty trials involving 1835 patients were included. No significant differences were observed in mortality (RR, 0.94; 95% CI, 0.69 to 1.28), endotracheal intubation (RR, 0.87; 95% CI, 0.71 to 1.06), PaCO 2 (MD, –0.87 mmHg; 95% CI, –2.98 to 1.25) or PaO 2 (MD, 2.67 mmHg; 95% CI, –0.66 to 6.01). However, HFNC significantly reduced hospital stay (MD, –0.69 days; 95% CI, –1.08 to –0.30) and ICU stay (MD, –0.98 days; 95% CI, –1.50 to –0.45), lowered nasal skin breakdown risk (RR, 0.20; 95% CI, 0.09 to 0.45) and improved comfort (MD, –1.19; 95% CI, –1.98 to –0.41). Subgroup and sensitivity analyses confirmed the principal findings. Conclusions HFNC was not significantly different from NIV for mortality and endotracheal intubation in HRF but was associated with shorter hospital and ICU stays, reduced nasal facial skin breakdown and improved comfort. Larger trials in diverse populations are needed.