High-Flow Nasal Cannula Versus Non-Invasive Ventilation in Immunocompromised Adults with Acute Respiratory Failure: A Systematic Review and Meta-Analysis

Abstract

Background & Objective: Acute respiratory failure (ARF) is a typical cause of intensive care unit (ICU) admission and is linked with substantial morbidity and mortality, particularly among immunocompromised patients. Noninvasive ventilation (NIV) has been employed to avoid invasive mechanical ventilation; however, high-flow nasal cannula (HFNC) oxygen therapy has proved itself as an effective alternative. Evidence comparing the response of HFNC and NIV in immunocompromised patients with ARF remains inconsistent. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of HFNC compared with NIV in immunocompromised adults with acute hypoxemic respiratory failure. Methodology: A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted from database inception to October 2024. Randomized controlled trials and observational studies comparing HFNC with NIV in immunocompromised adults with ARF were included. The primary outcomes were the incidence of endotracheal intubation and mortality. The secondary outcomes that were analyzed include ventilator duration, ICU length of stay, hospital length of stay, and adverse events. Pooled analyses were performed utilizing a random effects model, with risk ratios (RR) or mean differences (MD) and 95% confidence intervals (CI). Results: Six studies comprising 432 patients (217 HFNC and 215 NIV) were included. HFNC was linked with a non-significant decline in the risk of intubation (RR 0.77, 95% CI 0.51–1.16) and a borderline decrease in mortality (RR 0.73, 95% CI 0.53–1.00). Both interventions showed comparable results in outcomes, like ventilator duration, ICU stay, or hospital stay. HFNC resulted in fewer adverse events compared with NIV, although the difference was not statistically significant. Conclusion: HFNC may yield a potential improvement in survival and reduce intubation risk in immunocompromised patients with ARF while maintaining comparable clinical outcomes to NIV. Future large-scale randomized studies are required to establish the reliability of these findings. Key Words: High flow nasal cannula, Non invasive ventilation, Acute respiratory failure.