Cánula nasal de alto flujo frente a ventilación mecánica no invasiva en la insuficiencia respiratoria aguda hipoxémica: revisión crítica según fenotipos y riesgo de intubación

Diana Marcela Alzate-Garcia; Jesus Andres Montano-Saavedra; Yei Alberto Jaimes-Uribe; Robert Junior Algarin-Mendoza; Valeria Ángel-Hernández; Ashley Nabil Nagi-Prieto; Adriana José Agamez-Utria; Byron De Jesus Díaz-Lasso; María Paula Motta-Aguirre; Daniela Simanca-Arias

Authors

Alzate-Garcia Diana Marcela Universidad de Manizales. Manizales, Colombia. https://orcid.org/0009-0000-5643-9619
Montano-Saavedra Jesus Andres Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0009-0008-8126-2737
Jaimes-Uribe Yei Alberto Universidad Industrial de Santander. Bucaramanga, Colombia. https://orcid.org/0009-0002-7536-029X
Algarin-Mendoza Robert Junior Universidad Autónoma de Bucaramanga. Bucaramanga, Colombia. https://orcid.org/0009-0007-9152-8175
Ángel-Hernández Valeria Corporación Universitaria Alexander Von Humboldt. Armenia, Colombia. https://orcid.org/0000-0002-5086-0602
Nagi-Prieto Ashley Nabil Fundación Universitaria Sanitas. Bogotá, Colombia. https://orcid.org/0009-0003-1085-8625
Agamez-Utria Adriana José Universidad del Sinú. Cartagena, Colombia. https://orcid.org/0009-0004-5584-0864
Díaz-Lasso Byron De Jesus Fundación Universitaria Navarra. Neiva, Colombia. https://orcid.org/0009-0009-3352-2642
Motta-Aguirre María Paula Fundación Universitaria Navarra. Neiva, Colombia. https://orcid.org/0009-0004-2802-7456
Simanca-Arias Daniela Universidad del Sinú. Cartagena, Colombia. https://orcid.org/0009-0002-5235-5738

Keywords:

Acute respiratory failure; Hypoxemia; Noninvasive ventilation; High-flow nasal cannula; Intubation; Oxygen therapy

Abstract

DOI: https://doi.org/10.46296/gt.v9i17.0339

Abstract

Acute hypoxemic respiratory failure (AHRF) is a common ICU condition, often due to pneumonia, postoperative lung dysfunction, or pulmonary edema, and is characterized by severe hypoxemia without major hypercapnia(5). Noninvasive oxygenation strategies are critical to avoid endotracheal intubation and its complications (ventilator-induced lung injury, ventilator-associated pneumonia, etc.) (2). Two key approaches are high-flow nasal cannula (HFNC), which delivers heated humidified oxygen at high flow rates, and noninvasive ventilation (NIV) with positive pressure via a mask. This critical review compares HFNC vs NIV in AHRF, focusing on which patient phenotypes derive greater net benefit from each strategy and the certainty of evidence. We synthesize findings on intubation rates and mortality with each therapy, as well as other outcomes (ventilator-free days, therapy failure, patient comfort, and safety). Pre-specified subgroups are examined: “de novo” AHRF (e.g., pneumonia/ARDS without hypercapnia), post-surgical respiratory failure, cardiogenic pulmonary edema, and COPD exacerbation (hypercapnic phenotype). We also discuss sources of heterogeneity across studies (intubation criteria, NIV interface – helmet vs mask –, pressure settings, co-interventions like awake prone positioning) and safety considerations (risks of delayed intubation, barotrauma, aspiration, and patient self-inflicted lung injury). Results: In general AHRF, HFNC has proven at least as effective as NIV in preventing intubation, with better tolerance and potential survival advantages(3, 4). However, in specific phenotypes (e.g., hypercapnic COPD or cardiogenic edema), NIV remains the standard. Further research is needed to tailor the optimal support strategy to patient profiles.

Keywords: Acute respiratory failure; Hypoxemia; Noninvasive ventilation; High-flow nasal cannula; Intubation; Oxygen therapy.

Downloads

Download data is not yet available.

References

Matthay MA, Zemans RL, Zimmerman GA, et al. Acute respiratory distress syndrome. Nat Rev Dis Primers. 2019;5:18.

Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126-2136.

Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372(23):2185-2196.

Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of intubation in adult patients with acute respiratory failure? A meta-analysis. Chest. 2017;151(4):764-775.

Ni YN, Luo J, Yu H, et al. The effect of high-flow nasal cannula in reducing mortality and intubation when used before mechanical ventilation: a systematic review and meta-analysis. Am J Emerg Med. 2018;36(2):226-233.

Glenardi G, Chriestya F, Oetoro BJ, et al. Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis. Acute Crit Care. 2022;37(1):71-83.

Grieco DL, Menga LS, Cesarano M, et al. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen in COVID-19 patients with acute respiratory failure (HENIVOT trial). JAMA. 2021;325(17):1731-1743.

Altunbas E, Bayram N, Unal E, et al. Is high-flow nasal oxygen as effective as non-invasive ventilation in acute cardiogenic pulmonary edema? Am J Emerg Med. 2025;98:93-99.

Yang PL, Yu JQ, Chen HB. High-flow nasal cannula for acute exacerbation of COPD: a systematic review and meta-analysis. Heart Lung. 2023;60:116-126.

Vincent JL, Marshall JC, Ñamendys-Silva SA, et al. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. Lancet Respir Med. 2014;2(5):380-386.

Bellani G, Laffey JG, Pham T, et al. Epidemiology and patterns of care in ARDS. Intensive Care Med. 2016;42(9):1574-1585.

Lemiale V, Mokart D, Resche-Rigon M, et al. Effect of noninvasive ventilation vs oxygen therapy on 28-day mortality in immunosuppressed patients with acute respiratory failure. JAMA. 2015;314(16):1711-1719.

Cheng A, Sun B, Wang C, et al. Use of high-flow nasal cannula oxygen therapy in immunocompromised patients with acute respiratory failure: a meta-analysis. Medicina (Kaunas). 2019;55(10):693.

Stéphan F, Barrucand B, Petit P, et al. High-flow nasal oxygen vs noninvasive ventilation after cardiac surgery (BiPOP trial). JAMA. 2015;313(23):2331-2339.

Hernández G, Vaquero C, Colinas L, et al. Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation in high-risk patients. JAMA. 2016;316(15):1565-1574.

Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333(13):817-822.

Crimi C, Noto A, Princi P, et al. A European survey of noninvasive ventilation practices. Eur Respir J. 2010;36(2):362-369.

Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high-flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011;37(11):1780-1786.

Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195(9):1207-1215.

Carteaux G, Millán-Guilarte T, De Prost N, et al. Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: role of tidal volume. Crit Care Med. 2016;44(2):282-290.

Yoshida T, Fujino Y, Amato MB, Kavanagh BP. Spontaneous breathing during mechanical ventilation: risks, mechanisms, and management. Am J Respir Crit Care Med. 2017;195(8):985-992.

Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854-887.

Patel M, Gangoli G, Kline PA, et al. High-flow nasal cannula therapy in the emergency department: a comparison with noninvasive ventilation and conventional oxygen therapy. J Clin Med Res. 2016;8(10):817-822.