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. 2020 Jun 15;67(9):1217–1248. doi: 10.1007/s12630-020-01740-2

Table 1.

Characteristics of included studies for review on HFNC for acute hypoxemic respiratory failure

Study Country Number of patients randomized Population Intervention details Comparator details Duration of follow-up for mortality Outcomes
Azoulay, 201846 France 778

Inclusion: ICU patients, PaO2 < 60 mmHg or SpO2 <90% on R/A, immune-suppression

Exclusion: ↑ CO2, CPE, recent surgery

(Fisher and Paykel Healthcare)

Initial settings: Flow: 50 L·min−1 FiO2: 100%

Duration: not specified

NP or mask.

Initial settings:

Flow: set to achieve SpO2 ≥ 95%

 28 days Mortality (primary), need for IMV, escalation, ICU and hospital LOS, comfort and dyspnea
Bell, 201547 Australia 100

Inclusion: ED patients, RR ≥ 25 breaths·min−1, SpO2 ≤ 93%

Exclusion: Patients requiring immediate NIV or IMV

(AIRVO2, Optiflow,

Fisher & Paykel)

Initial settings:

Flow: 50 L·min−1 FiO2: 30%

Duration: 2 hr

NP or face mask

Initial settings:

O2 in both groups was titrated over a 2-hr period

 N/A Need for IMV, escalation, comfort
Frat, 201548 France and Belgium 313

Inclusion: ICU patients, ARF with RR > 25 breaths·min−1, PF ≤ 300, on ≥ 10 L·min−1 O2 for ≥ 15 min

Exclusion: asthma, chronic lung dz, ↑ CO2, CPE, CV instability, need for IMV

(Optiflow, MR850,

Fisher and Paykel Healthcare)

Initial settings:

Flow: 50 L·min−1

FiO2: 100%

Duration: not specified

NRB mask

Initial settings:

Flow: ≥ 10 L·min−1

 90 days Mortality (primary), need for IMV, escalation, ICU LOS, comfort
Geng, 202041 China 36

Inclusion: ICU, ED, or ward patients, acute asthma, PaO2 < 60 mmHg on R/A with or without ↑ CO2

Exclusion: urgent IMV, CV instability, aLOC, RR > 45 breaths·min−1, pH < 7.30

(AIRVO2, Fisher & Paykel)

Initial settings:

Flow: 30-40 L·min−1

FiO2: N/A

Duration: not specified

NP, Venturi mask, or storage balloon mask

Initial settings:

Flow: 2–6 L·min−1, set to achieve SpO2 92–96%

 N/A Need for IMV, escalation, hospital LOS
Jones, 201649 New Zealand 322

Inclusion: ED patients, SpO2 ≤ 92% on R/A, RR ≥ 22 breaths·min−1

Exclusion: Urgent NIV or IMV required

(Optiflow, Fisher & Paykel Healthcare)

Initial settings:

Flow: 40 L·min−1

FiO2: 28%

Duration: not specified

Mask or NP

Initial settings:

N/A

 90 days Mortality, need for IMV, escalation (primary), hospital LOS
Lemiale, 201545 France 102

Inclusion: ICU patients, immune-compromised, > 6 L·min−1 O2 to maintain SpO2 > 95% or respiratory distress

Exclusion: ↑ CO2, urgent NIV or IMV required

(Fisher &

Paykel Healthcare)

Initial settings:

Flow: 40–50 L·min−1

FiO2: 100%

Duration: 2 hr

Venturi mask

Initial settings:

Flow: 15 L·min−1

FiO2: 60%

 N/A Need for IMV, escalation (primary), dyspnea, comfort
Makdee, 201744 Thailand 136

Inclusion: ED patients, CPE, SpO2 < 95% on

R/A, RR >24 breaths·min−1

Exclusion: Urgent NIV or IMV required, CV instability, RR >35 breaths·min−1, SpO2 < 90%, ESRD

(Optiflow, Fisher & Paykel Healthcare)

Initial settings:

Flow: 35 L·min−1

FiO2: N/A

Duration: 1 hr

NP or NRB

Initial settings:

N/A

 7 days Mortality, need for IMV, escalation, hospital LOS, dyspnea, comfort
Parke, 201150 New Zealand 60

Inclusion: ICU patients, ≥ 4 L·min−1 O2 via NP

for > 4 hr or ≥ 6 L·min−1 O2 via a face mask

for > 2 hr and/or

RR ≥ 25 breaths·min−1 and/or ↑ WOB

Exclusion: Urgent NIV or IMV required

(Optiflow, Fisher & Paykel Healthcare)

Initial settings:

Flow: 35 L·min−1

FiO2: N/A

Duration: not specified

Face mask

Initial settings:

N/A

 N/A Escalation
Raeisi, 201942 Iran 40

Inclusion: ED or ward patients, moderate to severe asthma exacerbation

Exclusion:

Pregnancy with history of smoking and occupational asthma, ↑ CO2, Infiltrates on chest x-ray

Device not specified

Initial settings:

Flow: 19.5–30 L·min−1

FiO2: N/A

Duration: not specified

NP

Initial settings:

Flow: 2–5 L·min−1

 N/A Dyspnea
Rittayamai, 201551 Thailand 40

Inclusion: ED patients, RR > 24 breaths·min−1, SpO2 < 94% on R/A

Exclusion: Need for IMV, CV instability, CRF

(Optiflow, Fisher & Paykel Healthcare)

Initial settings:

Flow: 35 L·min−1

FiO2: N/A

Duration: 1 hr

NP or NRB

Initial settings:

N/A

 N/A Need for IMV, escalation, dyspnea (primary), comfort
Ruangsomboon, 201943 Thailand 48

Inclusion: ED palliative patients, SpO2 < 90%, RR ≥ 30 breaths·min−1, dyspneic

Exclusion: aLOC, unable to communicate, positive pressure devices contraindicated

(AIRVO2, Optiflow,

Fisher & Paykel)

Initial settings:

Flow: 35 L·min−1

FiO2: N/A

Duration: 1 hr

NP or NRB

Initial settings:

Set to achieve SpO2 > 95%

 N/A Dyspnea

Schwabbauer, 201452

(crossover)

 Germany 14

Inclusion: ICU patients, PaO2 < 55 mmHg on

R/A

Exclusion: CPE, CV instability

(OptiFlow,

Fisher & Paykel Healthcare)

Initial settings: Flow: 55 L·min−1

FiO2: 60%

Duration: 30 min

Venturi mask

Initial settings:

Flow: 15 L·min−1

FiO2: 60%

 N/A Dyspnea and comfort

aLOC = altered level of consciousness; ARF = acute respiratory failure; CPE = cardiogenic pulmonary edema; CRF = chronic respiratory failure; CV = cardiovascular; Dz = disease; ESRD = end stage renal disease; ED = emergency department; ESRD = end-stage renal disease; ICU = intensive care unit; IMV = invasive mechanical ventilation; LOS = length of stay; NIV = non-invasive ventilation; NP = nasal prongs; NRB = non-rebreathe mask; PaO2 = partial pressure of oxygen; PF = PaO2:FiO2 ratio; R/A = room air; RR = respiratory rate; SpO2 = peripheral oxygen saturation; WOB = work of breathing