Can high-flow nasal cannula reduce the rate of reintubation in adult patients after extubation? A meta-analysis

BMC Pulm Med. 2017 Nov 17;17(1):142. doi: 10.1186/s12890-017-0491-6.


Background: The effects of high flow nasal cannula (HFNC) on adult patients after extubation remain controversial. We aimed to further determine the effectiveness of HFNC in comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).

Methods: The Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trails (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all the controlled study comparing HFNC with NIPPV and COT in adult patients after extubation. The primary outcome was rate of reintubation and the secondary outcomes were intensive care unit (ICU) mortality and length of ICU stay (ICU LOS).

Results: Eight trials with a total of 2936 patients were pooled in our final studies. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with lower rate of reintubation (Z = 2.97, P = 0.003), and the same result was found in the comparison between HFNC and NIPPV (Z = 0.87, P = 0.38). As for the ICU mortality and ICU LOS, we did not find any advantage of HFNC over COT or NIPPV.

Conclusions: In patients after extubation, HFNC is a reliable alternative of NIPPV to reduce rate of reintubation compared with COT.

Keywords: Adult; High flow nasal cannula; Meta-analysis; Mortality; Post-extubation; Prognosis.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Airway Extubation
  • Cannula*
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Intubation, Intratracheal*
  • Length of Stay
  • Noninvasive Ventilation*
  • Oxygen / administration & dosage*
  • Oxygen Inhalation Therapy / methods*
  • Positive-Pressure Respiration*
  • Randomized Controlled Trials as Topic


  • Oxygen