High-Flow Nasal Cannula Versus Noninvasive Ventilation for Prevention of Reintubation in High-Risk Critically Ill Patients (HIGH-FLOW OXY): An Informative Systematic Review and Meta-Analysis
In brief
High-flow nasal cannula offers no reintubation benefit over NIV
A meta-analysis of 15 trials (2,073 high-risk ICU patients) found that high-flow nasal cannula did not lower the odds of reintubation within three days compared with noninvasive ventilation, and overall ICU mortality and infection rates were similar. In very high-risk and obese subgroups, HFNC may actually increase reintubation risk, highlighting the need for targeted trials.
- Journal
- Critical care explorations (Q1)
- Published
- 6 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Nhan Nguyen, Nathalia Alves de Barros E Lyra, David Downes, Nghi Bao Tran, Vinh Quang Tri Ho, Yacin Zawam, et al.
- PMID
- 42554971
- DOI
- 10.1097/CCE.0000000000001452
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 9 August 2026): HFNC vs NIV no difference in reintubation risk
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 9 August 2026).
Abstract
OBJECTIVES: Optimal postextubation respiratory support for critically ill patients at high risk of reintubation remains uncertain. We aimed to compare the efficacy of high-flow nasal cannula (HFNC) vs. noninvasive ventilation (NIV) in preventing reintubation among critically ill adults at high risk of extubation failure. DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov were systematically searched from inception through the latest available date. STUDY SELECTION: HIGH-FLOW OXY is a systematic review and meta-analysis comparing HFNC with NIV in ICU patients at high risk of extubation failure. The primary outcome was short-term reintubation within 3 days postextubation. Secondary outcomes included ICU mortality, ICU length of stay, sepsis, and nosocomial pneumonia. DATA EXTRACTION: Data were extracted using predefined criteria. Risk of bias (RoB) was assessed with the Cochrane tool, and certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation. Random-effects models were used for pooled analyses. Prespecified subgroup analyses included obese patients, very high-risk patients, elderly individuals, and those with acute exacerbations of chronic obstructive pulmonary disease. DATA SYNTHESIS: Fifteen randomized controlled trials (RCTs; n = 2073) were included. HFNC and NIV did not differ significantly in reintubation (odds ratio [OR], 1.19; 95% CI, 0.88-1.59), ICU mortality (OR, 0.74; 95% CI, 0.40-1.38), sepsis (OR, 1.29; 95% CI, 0.71-2.35), nosocomial pneumonia (OR, 1.01; 95% CI, 0.67-1.52), or ICU length of stay (MD -0.37 d; 95% CI, -1.42 to 0.68). Subgroup analyses suggested a higher reintubation risk with HFNC among very high-risk patients (OR, 1.63; 95% CI, 1.05-2.53) and nonoperative obese patients (OR, 2.52; 95% CI, 1.45-4.38). Sensitivity analysis excluding trials at high RoB indicated a potential increase in reintubation with HFNC (OR, 1.32; 95% CI, 1.02-1.71). Overall, certainty of evidence was low across outcomes. CONCLUSIONS: Among ICU patients at high risk of extubation failure, HFNC did not reduce reintubation compared with NIV, and may be associated with increased risk in selected high-risk subgroups. Further adequately powered, risk-stratified RCTs are warranted to define the optimal postextubation respiratory support strategy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.