The efficacy and safety of high-flow nasal cannula therapy in patients with COPD and type II respiratory failure: a meta-analysis and systematic review

Background High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have been used for the treatment of COPD and respiratory failure in clinical settings. We aimed to evaluate the efficacy and safety of HFNC therapy in patients with COPD and type II respiratory failure, to provide evidence to the clinical COPD management. Methods We searched Cochrane et al. databases up to Dec 31, 2020 for randomized controlled trials (RCTs) on the use of HFNC therapy in patients with COPD and type II respiratory failure. Two researchers independently screened the literature according to the inclusion and exclusion criteria, and evaluated the quality of the literature and extracted data. We used Revman5.3 software for statistical analysis of collected data. Results A total of 6 RCTs involving 525 COPD and type II respiratory failure patients. Meta-analyses indicated that compared with NIV, HFNC could significantly reduce PaCO2 level (MD = - 2.64, 95% CI (- 3.12 to - 2.15)), length of hospital stay ((MD = - 1.19, 95 CI (- 2.23 to - 0.05)), the incidence of nasal facial skin breakdown ((OR = 0.11, 95% CI (0.03-0.41)). And there were no significant differences between the two groups in PaO2 ((MD = 2.92, 95% CI (- 0.05 to 5.90)), incidence of tracheal intubation ((OR = 0.74, 95% CI (0.34-1.59)) and mortality (OR = 0.77, 95% CI (0.28-2.11)). Conclusions HFNC is more advantageous over NIV in the treatment of COPD and type II respiratory failure. Future studies with larger sample size and strict design are needed to further elucidate the role of HFNC in COPD and respiratory failure.

Automated summary

High-flow nasal cannula (HFNC) therapy is more advantageous over noninvasive ventilation (NIV) in treating COPD and type II respiratory failure patients, as it can significantly lower PaCO2 levels and reduce the length of hospital stay. There were no significant differences in oxygenation levels, incidence of tracheal intubation, and mortality between HFNC and NIV therapy. Further studies with larger sample sizes and rigorous designs are needed to clarify the role of HFNC in COPD and respiratory failure.