Efficacy of high-flow nasal cannula in patients with acute heart failure: a systematic review and meta-analysis

Background Acute heart failure (AHF) is often associated with diffuse insufficiency and arterial hypoxemia, requiring respiratory support for rapid and effective correction. We aimed to compare the effects of high-flow nasal cannula(HFNC) with those of conventional oxygen therapy(COT) or non-invasive ventilation(NIV) on the prognosis of patients with AHF. Methods We performed the search using PubMed, Embase, Web of Science, MEDLINE, the Cochrane Library, CNKI, Wanfang, and VIP databases from the inception to August 31, 2023 for relevant studies in English and Chinese. We included controlled studies comparing HFNC with COT or NIV in patients with AHF. Primary outcomes included the intubation rate, respiratory rate (RR), heart rate (HR), and oxygenation status. Results From the 1288 original papers identified, 16 studies met the inclusion criteria, and 1333 patients were included. Compared with COT, HFNC reduced the intubation rate (odds ratio [OR]: 0.29, 95% CI: 0.14–0.58, P = 0.0005), RR (standardized mean difference [SMD]: -0.73 95% CI: -0.99 – -0.47, P < 0.00001) and HR (SMD: -0.88, 95% CI: -1.07 – -0.69, P < 0.00001), and hospital stay (SMD: -0.94, 95% CI: -1.76 – -0.12, P = 0.03), and increase arterial oxygen partial pressure (PaO2), (SMD: 0.88, 95% CI: 0.70–1.06, P < 0.00001) and oxygen saturation (SpO2 [%], SMD: 0.70, 95% CI: 0.34–1.06, P = 0.0001). Conclusions There were no significant differences in intubation rate, RR, HR, arterial blood gas parameters, and dyspnea scores between the HFNC and NIV groups. Compared with COT, HFNC effectively reduced the intubation rate and provided greater clinical benefits to patients with AHF. However, there was no significant difference in the clinical prognosis of patients with AHF between the HFNC and NIV groups. Trial registration PROSPERO (identifier: CRD42022365611). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-023-02782-0.

3 Describe the rationale for the review in the context of existing knowledge.Page1 Objectives 4 Provide an explicit statement of the objective(s) or question(s) the review addresses.Page2

Eligibility criteria
5 Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.Page2 Information sources 6 Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies.Specify the date when each source was last searched or consulted.

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Search strategy 7 Present the full search strategies for all databases, registers and websites, including any filters and limits used.

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Selection process 8 Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.

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Data collection process 9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.

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Data items 10a List and define all outcomes for which data were sought.Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.

appendix file 1(flow diagram)
10b List and define all other variables for which data were sought (e.g.participant and intervention characteristics, funding sources).Describe any assumptions made about any missing or unclear information.

appendix file 1(flow diagram)
Study risk of bias assessment 11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.

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Effect measures 12 Specify for each outcome the effect measure(s) (e.g.risk ratio, mean difference) used in the synthesis or presentation of results.Page4 Synthesis methods 13a Describe the processes used to decide which studies were eligible for each synthesis (e.g.tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).
13b Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions.
13c Describe any methods used to tabulate or visually display results of individual studies and syntheses.
13d Describe any methods used to synthesize results and provide a rationale for the choice(s).If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.

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13e Describe any methods used to explore possible causes of heterogeneity among study results (e.g.subgroup analysis, meta-regression).
13f Describe any sensitivity analyses conducted to assess robustness of the synthesized results.

Reporting bias assessment
14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).16b Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.

Results of individual studies
19 For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g.confidence/credible interval), ideally using structured tables or plots.
methods used to assess certainty (or confidence) in the body of evidence for an outcome.Page3RESULTSStudy selection16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.appendixfile 1(flow diagram) synthesis, briefly summarise the characteristics and risk of bias among contributing studies.Page6-10 20b Present results of all statistical syntheses conducted.If meta-analysis was done, present for each the summary estimate and its precision (e.g.confidence/credible interval) and measures of statistical heterogeneity.If comparing groups, describe the direction of the effect.Page6-10 20c Present results of all investigations of possible causes of heterogeneity among study results.Page12 20d Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.Page4 Reporting biases 21 Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.Page3 Certainty of evidence 22 Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.Page6-10 DISCUSSION Discussion 23a Provide a general interpretation of the results in the context of other evidence.Page12 23b Discuss any limitations of the evidence included in the review.Page12 23c Discuss any limitations of the review processes used.Page12 23d Discuss implications of the results for practice, policy, and future research.Page12OTHER INFORMATIONRegistration and protocol24a Provide registration information for the review, including register name and registration number, or state that the review was not registered.Page224b Indicate where the review protocol can be accessed, or state that a protocol was not prepared.24cDescribe and explain any amendments to information provided at registration or in the protocol.Support 25 Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.Competing 26 Declare any competing interests of review authors.None