R.E.B.E.L.EM - March 9, 2020 - By Jenny Beck-Esmay
Article: Tinelli V et al. High Flow Nasal Cannula Oxygen Vs. Conventional Oxygen Therapy and Noninvasive Ventilation in Emergency Department Patients: A Systematic Review and Meta-Analysis. JEM 2019. PMID: 31421952
"Clinical Question: In patients with acute respiratory failure in the ED, does conventional oxygen therapy vs high flow nasal cannula vs noninvasive ventilation reduce intubation requirements?
Author Conclusion: “We did not find any benefit of HFNC compared with COT and NIV in terms of intubation requirement, treatment failure, hospitalization, and mortality; COT was better tolerated.”
Clinical Take Home Point: This meta-analysis does not answer the primary question of COT vs HFNC in acute respiratory failure in the ED, due to the small number of trials, the methodological issues mentioned above, and the heterogeneity in the causes of acute respiratory failure, which are not defined in the review. The best we can say, is use the oxygen delivery device that improves oxygen saturation, ventilation where needed, and most comfortable for the patient. This will most likely vary depending on the cause and severity of acute respiratory failure."