OBJECTIVES: To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in providing respiratory support of children with acute lower respiratory infection (ALRI), hypoxemia, and respiratory distress. STUDY DESIGN: We performed a meta-analysis of randomized controlled trials that compared HFNC and standard flow oxygen therapy or nasal continuous positive airway pressure (nCPAP) and reported treatment failure as an outcome. Data were synthesized using Mann-Whitney U test. RESULTS: Compared with standard oxygen therapy, HFNC significantly reduced treatment failure (risk ratio (RR) 0.49, 95% CI 0.40 to 0.60, p < 0.001) in children with mild hypoxemia (arterial pulse oximetry (SpO2) > 90% on room air). HFNC had an increased risk of treatment failure compared with nCPAP in infants age 1 to 6 months with severe hypoxemia (SpO2 < 90% on room air or SpO2 > 90% on supplemental oxygen) (RR 1.77, 95% CI 1.17 to 2.67, p = 0.007). No significant differences were found in intubation rates and mortality between HFNC and standard oxygen therapy or nCPAP. HFNC had a lower risk of nasal trauma compared with nCPAP (RR 0.35, 95% CI 0.16 to 0.77, p = 0.009). CONCLUSIONS: Among children < 5 years of age with ALRI, respiratory distress, and mild hypoxemia, HFNC reduced the risk of treatment failure when compared with standard oxygen therapy. However, nCPAP was associated with a lower risk of treatment failure than HFNC in infants age 1 to 6 months with ALRI, moderate-to-severe respiratory distress, and severe hypoxemia. No differences were found in intubation and mortality between HFNC and standard oxygen therapy or nCPAP.

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