• Valentina Tinelli, Luca Cabrini, Evgeny Fominskiy, Stefano Franchini, Luca Ferrante, Lorenzo Ball, Paolo Pelosi, Giovanni Landoni, Alberto Zangrillo, and Antonio Secchi.
• Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J Emerg Med. 2019 Sep 1; 57 (3): 322-328.

BackgroundAcute respiratory failure (ARF) is a common cause of presentation to the Emergency Department (ED). High flow nasal cannula (HFNC) has been introduced as an alternative way to administer oxygen.ObjectivesWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing HFNC with conventional oxygen therapy (COT) and noninvasive ventilation (NIV) exclusively in the ED setting.MethodsInclusion criteria were: RCTs on adults with ARF admitted to the ED, investigating HFNC vs. COT or other modes of ventilation. Trials that compared HFNC support outside the ED, were published as an abstract, or nonrandomized were excluded.ResultsFour RCTs comparing HFNC with COT and one HFNC to NIV met the criteria. Overall, 775 patients were included. The meta-analysis of the studies comparing HFNC and COT showed no differences in intubation requirement, treatment failure, hospitalization, or mortality. Intolerance was significantly higher with HFNC (risk ratio 6.81 95% confidence interval 1.18-39.19; p = 0.03). In the only available RCT comparing HFNC with NIV, no difference was found for intubation rate, treatment failure, tolerance, and dyspnea.ConclusionsWe 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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