High-flow nasal oxygen is increasingly used for the management of acute respiratory failure because of its perceived advantages over conventional oxygen therapy and noninvasive ventilation. However, the comparative clinical benefits and harms of high-flow nasal oxygen aren't well known. To develop a clinical guideline for the use of high-flow nasal oxygen in acute respiratory failure, researchers reviewed randomized clinical trials that compared high-flow nasal oxygen with conventional oxygen therapy or noninvasive ventilation in hospitalized adults.

A total of 29 trials were included in the analysis. When compared with noninvasive ventilation for the initial management of acute respiratory failure, high-flow nasal oxygen may reduce intubation, all-cause mortality, and hospital-acquired pneumonia and may improve patient comfort. When compared with noninvasive ventilation for postextubation management, high-flow nasal oxygen may increase reintubation and mortality.

Compared with conventional oxygen therapy, high-flow nasal oxygen may reduce reintubation and improve patient comfort in postextubation management, but its benefits were less clear in the initial management of acute respiratory failure. In addition, high-flow nasal oxygen may lead to fewer facial skin breakdown events compared with noninvasive ventilation and less treatment escalation compared with conventional oxygen therapy.

Among the limitations of the study were that trials varied in terms of the populations enrolled, the causes of acute respiratory failure, and the protocols used.