Medicina intensiva · 2026
Clinical utility of high-flow nasal cannula versus non-invasive mechanical ventilation in patients with acute hypercapnic respiratory failure: A scoping review.
СтатьяScoping ReviewСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Varón-Vega Fabio, Tuta-Quintero Eduardo, Robayo Henry
Аннотация
OBJECTIVE: To map and describe the available evidence comparing the efficacy, tolerance, and clinical outcomes of high-flow nasal cannula (HFNC) versus non-invasive ventilation (NIV) in adults with acute hypercapnic respiratory failure.
DESIGN: Scoping review conducted in accordance with PRISMA-ScR and the Arksey & O'Malley framework, with Levac et al. refinements.
SETTING: Hospital settings, including emergency departments, intensive care units, and general wards managing adults with acute hypercapnic respiratory failure.
PARTICIPANTS: Adults with acute hypercapnic respiratory failure treated with HFNC or NIV.
INTERVENTIONS: HFNC or NIV used as initial ventilatory support or as an alternative when the first modality was not tolerated.
MAIN VARIABLES OF INTEREST: Treatment failure (defined as endotracheal intubation or mortality), changes in arterial blood gases, respiratory rate, tolerance, and adverse events.
RESULTS: Of 513 records screened, 8 full-text studies met the inclusion criteria. In 62% (5/8) of the studies, treatment failure was the primary outcome. A total of 779 patients were analyzed, of whom 381 (48.9%) received HFNC. The included studies were heterogeneous in terms of patient selection, clinical setting, ventilatory parameters, and definitions of failure. Across studies, randomized trials more frequently reported lower failure rates with NIV, whereas HFNC was consistently associated with better tolerance. Due to marked heterogeneity and the scoping nature of the review, no pooled estimates or formal comparative analyses were performed.
CONCLUSION: The available evidence on HFNC versus NIV in acute hypercapnic respiratory failure is heterogeneous and derived from diverse clinical settings. While NIV remains the reference standard and is often associated with lower treatment failure, HFNC appears to be a well-tolerated alternative, particularly in patients with NIV intolerance. Further well-designed studies are needed to better define the role of HFNC in this population.
DESIGN: Scoping review conducted in accordance with PRISMA-ScR and the Arksey & O'Malley framework, with Levac et al. refinements.
SETTING: Hospital settings, including emergency departments, intensive care units, and general wards managing adults with acute hypercapnic respiratory failure.
PARTICIPANTS: Adults with acute hypercapnic respiratory failure treated with HFNC or NIV.
INTERVENTIONS: HFNC or NIV used as initial ventilatory support or as an alternative when the first modality was not tolerated.
MAIN VARIABLES OF INTEREST: Treatment failure (defined as endotracheal intubation or mortality), changes in arterial blood gases, respiratory rate, tolerance, and adverse events.
RESULTS: Of 513 records screened, 8 full-text studies met the inclusion criteria. In 62% (5/8) of the studies, treatment failure was the primary outcome. A total of 779 patients were analyzed, of whom 381 (48.9%) received HFNC. The included studies were heterogeneous in terms of patient selection, clinical setting, ventilatory parameters, and definitions of failure. Across studies, randomized trials more frequently reported lower failure rates with NIV, whereas HFNC was consistently associated with better tolerance. Due to marked heterogeneity and the scoping nature of the review, no pooled estimates or formal comparative analyses were performed.
CONCLUSION: The available evidence on HFNC versus NIV in acute hypercapnic respiratory failure is heterogeneous and derived from diverse clinical settings. While NIV remains the reference standard and is often associated with lower treatment failure, HFNC appears to be a well-tolerated alternative, particularly in patients with NIV intolerance. Further well-designed studies are needed to better define the role of HFNC in this population.