High-flow nasal cannula versus non-invasive ventilation following planned extubation in critically ill adults: a systematic review of clinical outcomes
DOI:
https://doi.org/10.65759/wsfjbm86Keywords:
High-flow nasal cannula, non-invasive ventilation, extubation, reintubation, intensive care unitAbstract
Background: Planned extubation in critically ill adults remains followed by clinically important rates of respiratory failure, reintubation, pneumonia, prolonged intensive care stay, and death. High-flow nasal cannula provides heated humidified gas, stable oxygen delivery, washout of upper airway dead space, and low-level positive airway pressure, while non-invasive ventilation provides pressure support and expiratory pressure through a mask interface. Objective: This systematic review compared high-flow nasal cannula with non-invasive ventilation, including alternating strategies, after planned extubation in critically ill adults. Methods: PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception to 2025 for adult studies evaluating high-flow nasal cannula versus non-invasive ventilation after planned extubation. Randomized trials and comparative observational studies were eligible. Outcomes included reintubation, postextubation respiratory failure, treatment failure, mortality, gas exchange, comfort, intolerance, complications, and intensive care length of stay. Results: Fourteen original studies were included. In broad high-risk intensive care populations, high-flow nasal cannula showed similar reintubation outcomes to non-invasive ventilation in one large trial, while combined high-flow nasal oxygen plus non-invasive ventilation reduced reintubation compared with high-flow nasal oxygen alone. In COPD, hypercapnia, obesity, and very high-risk groups, evidence favored individualized selection rather than a single universal device. Conclusion: High-flow nasal cannula represents a practical alternative after planned extubation for many critically ill adults, while non-invasive ventilation is important for hypercapnic, obese, and very high-risk phenotypes.
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