High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Figures & data

Table 1 Characteristics of Included Studies

Authors Year	Methods	Intervention	Language	Age (Years)		Gender (Male/Total)		APACHE II Score		PaCO2, mmHg		Outcomes
				HFNC	NIV	HFNC	NIV	HFNC	NIV	HFNC	NIV
Zhang 2018^Citation17	RCT	HFNC vs NIV	Chinese	64.5±5.3	66.1±6.6	18/21	20/24	16.3±1.4	16.7±1.6	42.9±7.7	43.3±8.1	①②③④⑤⑥
Yu 2019^Citation18	RCT	HFNC vs NIV	Chinese	62.4±10.1	63.5±11.2	24/36	21/36	28.6±2.8	28.5±3.4	73.56±6.9	73.50±6.23	①②③④⑤⑥⑦⑧⑨
Jing 2019^Citation19	RCT	HFNC vs NIV	English	77.4±6.8	73.9 ±6.9	NA	NA	11.8±3.1	10.4±2.5	53.2±6.7	53.7 ±8.6	①②③④⑤⑥⑦⑧⑨
Yang 2020^Citation20	RCT	HFNC vs NIV	Chinese	69±9	67±9	25/40	20/33	12.3±1.9	12.1±1.8	55±9	56±8	①②⑤
Thille 2021^Citation21	RCT	HFNC vs NIV	English	66±9	66±9	48/64	61/86	NA	NA	44±9	43±8	①②④
Xu 2021^Citation22	RCT	HFNC vs NIV	English	69.22 ±6.13	68.39 ±5.22	NA	NA	NA	NA	NA	NA	①③⑤⑥⑦
Fang 2021^Citation23	RCT	HFNC vs NIV	Chinese	67.9±6.9	72.3±7.8	14/20	11/24	14.3±3.8	15.0±2.9	39.4±6.5	40.0±8.9	①②③④⑤⑦⑧⑨
Tan 2020^Citation24	RCT	HFNC vs NIV	English	68.4± 9.3	71.4± 7.8	27/44	23/42	14(11–18.8)	13(10.8–16)	50.5(48–57.8)	53(48.8–61.3)	①②③④⑤⑥⑦⑧⑨

Notes: Outcomes:①reintubation rates②mortality③complication rates④ length of ICU stay ⑤PaCO₂ ⑥ PaO₂/FiO₂ ⑦RR ⑧ HR ⑨PH.

Abbreviations: RCT, randomized controlled trial; HFNC, high-flow nasal cannula; NIV, non-invasive ventilation; NA, not applicable.

Figure 1 PRISMA (preferred reporting items for systematic reviews and meta-analysis) flow diagram.

Notes: Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:160. Creative Commons.¹⁵

Figure 2 Forest plot of reintubation rates, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Figure 3 Forest plot of mortality, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Figure 4 Forest plot of ICU length of stay, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Figure 5 Forest plot of complication rates, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Table 2 Other Outcome Measures

Outcomes (Units)	Pooling Model	Subgroup	Inclusion Studies	Results
				I^2 (%)	MD (95% CI)	P-value
PaCO2 (mmHg)	Random	Hypercapnia	5^Citation18–20,Citation22,Citation24	93.3	−0.37 (−1.21,0.46)	0.378
		Non-hypercapnia	2^Citation17,Citation23	0.0	0.28 (−0.14,0.70)	0.186
		Overall	7	91.1	−0.19 (−0.84,0.45)	0.561
HR (bpm)	Random	Hypercapnia	3^Citation18,Citation19,Citation24	78.9	−0.42 (−1.05,0.21)	0.191
		Non-hypercapnia	1^Citation23	0.00	−0.24 (−0.83,0.36)	0.435
		Overall	4	69.2	−0.38 (−0.85,0.09)	0.115
RR (bpm)	Fixed	Hypercapnia	4^Citation18,Citation19,Citation22,Citation24	0.0	−0.58 (−0.81,-0.35)	0.000
		Non-hypercapnia	1^Citation23	63.6	−0.07 (−0.67,0.52)	0.807
		Overall	5	20.0	−0.51 (−0.73,-0.30)	0.000
PH	Random	Hypercapnia	3^Citation18,Citation19,Citation24	85.9	0.52 (−0.26,1.30)	0.191
		Non-hypercapnia	1^Citation23	0.0	−0.10 (−0.69,0.49)	0.739
		Overall	4	81.7	0.37 (−0.25,0.98)	0.240
PaO2/FiO2 (mmHg)	Random	Hypercapnia	4^Citation18,Citation19,Citation22,Citation24	54.0	0.30 (−0.05,0.64)	0.093
		Non-hypercapnia	1^Citation17	0.0	−0.55 (−1.15,0.05)	0.070
		Overall	5	71.0	0.14 (−0.27,0.54)	0.514

Abbreviations: PaCO₂, partial pressure of arterial carbon dioxide; HR, heart rate; RR, respiratory rate; PaO₂, partial pressure of oxygen; FiO₂, fraction of inspired oxygen.

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