The role of high-flow nasal cannula during and before intubation
is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review
and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation
We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).
We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation
Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation
). Secondary outcomes included peri-intubation
complications, apneic time, Pao2
before and after intubation
, ICU length of stay, and short-term mortality.
We included 10 randomized clinical trials (n
= 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation
hypoxemia (relative risk, 0.98; 95% CI, 0.68–1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71–1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), Pao2
measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao2
measured after intubation
(mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation Paco2
, ICU length of stay, or 28-day mortality.
We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation
period when compared with conventional oxygen therapy.