High-flow nasal cannula versus standard oxygen therapy for adult acute hypoxemic respiratory failure: a systematic review and meta-analysis with trial sequential analysis and GRADE assessment.
Zhu L et al., 2026 · 10 studies included
Summary
Ten independent RCTs, reported in eleven publications, compared HFNC with standard oxygen in adult acute hypoxemic failure; search ended March 2026.
Conclusion
Intubation RR 0.85 (95% CI 0.77–0.93), low certainty; mortality RR 1.01 (0.88–1.16), moderate certainty. Trial-sequential monitoring boundaries were not crossed. Possible intubation benefit does not establish survival benefit or justify delaying escalation. Interpret alongside SOHO and ATS 2026, not as an exhaustive synthesis of later publications.