REVIEW article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1594145
Meta-Analysis of High-Flow Nasal Cannula Oxygen Therapy Versus Non-Invasive Ventilation After Invasive Mechanical Ventilation
Provisionally accepted
Mailidan Maimaitiniyazi1,2
chenfei Zhang1,2Muyesaier Maimaitiniyazi2Meiheliya Maisuti2Ailifeire Aihaiti1,2Tuersunayi Yisimiti1,2Yilizhati Nijiati1,2Nijiati Muyesai1,2*- 1People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
- 2Xinjiang Medical University, Ürümqi, Xinjiang Uyghur Region, China
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[Abstract] Objective: To compare high-flow nasal cannula (HFNC) oxygen therapy and non-invasive ventilation (NIV) for patients after liberation from invasive mechanical ventilation, to assess whether HFNC is better than NIV at improving blood gases [PaO₂, PaCO₂, and oxygenation index (OI)], reducing re-intubation rates, pulmonary infections, mortality, and shortening the length of stay in intensive care unit (ICU), and to evaluate if HFNC is a feasible alternative to NIV for respiratory support. Methods: This meta-analysis included randomized controlled trials (RCTs) and non-RCTs (NRCTs) from PubMed, Web of Science, CNKI, and Wanfang for further assessment. Evaluation indexes included PaO₂, PaCO₂, OI, re-intubation rate, pulmonary infection rate, length of stay in ICU, and mortality rate. Results: HFNC showed higher PaO₂ [MD=2.95, 95%CI (2.23,3.67), P<0.00001], lower PaCO₂ [MD=-3.04, 95%CI (-3.56,-2.52), P<0.00001], higher OI [MD=10.98, 95%CI (6.52,15.45), P<0.00001], lower re-intubation rate [OR=0.45, 95%CI (0.33,0.63), P<0.00001], and shorter length of stay in ICU [MD=-6.15, 95%CI (-6.86,-5.44), P<0.00001] compared to NIV. Additionally, no significant differences in pulmonary infection rate [OR=0.57, 95%CI (0.29,1.11), P=0.10] or mortality [OR=1.29, 95%CI (0.96,1.72), P=0.09] were observed between HFNC and NIV. Conclusion: HFNC can improve PaO₂ and OI, reduce PaCO₂, re-intubation rate, and length of stay in ICU, with no difference in pulmonary infection or mortality compared to NIV, supporting it as a viable clinical alternative for post-extubation respiratory support.
Keywords: HFNC, NIV, Invasive mechanical ventilation, Meta-analysis, respiratory failure
Received: 15 Mar 2025; Accepted: 26 Aug 2025.
Copyright: © 2025 Maimaitiniyazi, Zhang, Maimaitiniyazi, Maisuti, Aihaiti, Yisimiti, Nijiati and Muyesai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Nijiati Muyesai, People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
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