OBJECTIVES: Reintubation after failed extubation is associated with increased mortality and longer hospital length of stay. Noninvasive oxygenation modalities may prevent reintubation. We conducted a systematic review and meta-analysis to determine the safety and efficacy of high-flow nasal cannula after extubation in critically ill adults. DATA SOURCES: We searched Medline, Embase, and Web of Science. STUDY SELECTION: We included randomized controlled trials comparing high-flow nasal cannula to other noninvasive methods of oxygen delivery after extubation in critically ill adults. DATA EXTRACTION: We included the following outcomes: reintubation, postextubation respiratory failure, mortality, use of noninvasive ventilation, ICU and hospital length of stay, complications, and comfort. DATA SYNTHESIS: We included eight randomized controlled trials (n = 1,594 patients). Compared with conventional oxygen therapy, high-flow nasal cannula decreased reintubation (relative risk 0.46; 95% CI 0.30 to 0.70; moderate certainty) and postextubation respiratory failure (relative risk 0.52; 95% CI 0.30 to 0.91; very low certainty), but had no effect on mortality (relative risk 0.93; 95% CI 0.57 to 1.52; moderate certainty), or ICU length of stay (mean difference 0.05 d fewer; 95% CI 0.83 d fewer to 0.73 d more; high certainty). High-flow nasal cannula may decrease use of noninvasive ventilation (relative risk 0.64; 95% CI 0.34 to 1.22; moderate certainty) and hospital length of stay (mean difference 0.98 d fewer; 95% CI 2.16 d fewer to 0.21 d more; moderate certainty) compared with conventional oxygen therapy, however, certainty was limited by imprecision. Compared with noninvasive ventilation, high-flow nasal cannula had no effect on reintubation (relative risk 1.16; 95% CI 0.86 to 1.57; low certainty), mortality (relative risk 1.12; 95% CI 0.82 to 1.53; moderate certainty), or postextubation respiratory failure (relative risk 0.82; 95% CI 0.48 to 1.41; very low certainty). High-flow nasal cannula may reduce ICU length of stay (moderate certainty) and hospital length of stay (moderate certainty) compared with noninvasive ventilation. CONCLUSIONS: High-flow nasal cannula reduces reintubation compared with conventional oxygen therapy, but not compared with noninvasive ventilation after extubation.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher