Chronic obstructive pulmonary disease can lead to acute hypercapnic respiratory failure (AHRF), often treated using noninvasive ventilation (NIV). Emerging research suggests the potential utility of high flow nasal cannula (HFNC) for AHRF. This systematic review and meta-analysis aimed to determine the effect of HFNC versus NIV on AHRF management. A search of electronic databases (CINAHL, MEDLINE, and Academic Search Complete), web sources, and trial registries was last conducted on 9 February 2023. Quality and risk of bias assessments were conducted. Meta-analyses were used to synthesise data. Seven randomised controlled trials were included. No statistically significant differences between HFNC and NIV were found within the following outcomes of interest: (i) correction of pCO2: standardised mean difference (SMD) = −0.16, 95% confidence interval (CI) (−0.34 to 0.02), p = 0.08; (ii) correction of pH: SMD = −0.05, 95% CI (−0.25 to 0.14), p = 0.59; (iii) correction of pO2: SMD = −0.15, 95% CI (−0.40 to 0.09), p = 0.22; (iv) intubation rates: risk ratio (RR) = 0.87, 95% CI (0.41 to 1.82), p = 0.71; (v) mortality rates: RR = 0.85, 95% CI (0.47 to 1.56), p = 0.61; and (vi) treatment switch: RR = 1.30, 95% CI (0.43 to 3.94), p = 0.64. More controlled trials with large sample sizes are required to investigate the management of AHRF of various aetiologies. HFNC may be used as a final exhaustive measure for COPD-related AHRF where NIV is not tolerated, and when it is not clinically indicated to extend to endotracheal intubation.

中文翻译：

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高流量鼻插管与无创通气治疗急性高碳酸血症呼吸衰竭的系统评价和荟萃分析

慢性阻塞性肺疾病可导致急性高碳酸血症呼吸衰竭 (AHRF)，通常使用无创通气 (NIV) 进行治疗。新兴研究表明高流量鼻插管 (HFNC) 对于 AHRF 具有潜在用途。本系统回顾和荟萃分析旨在确定 HFNC 与 NIV 对 AHRF 管理的影响。最后一次于 2023 年 2 月 9 日对电子数据库（CINAHL、MEDLINE 和学术检索完成）、网络资源和试验注册进行检索。进行了质量和偏倚风险评估。荟萃分析用于综合数据。纳入了七项随机对照试验。在以下感兴趣的结果中，HFNC 和 NIV 之间没有发现统计学显着差异：(i) pCO2 校正：标准化平均差 (SMD) = -0.16，95% 置信区间 (CI)（-0.34 至 0.02），p  = 0.08；(ii) pH 校正：SMD = -0.05，95% CI（-0.25 至 0.14），p  = 0.59；(iii) pO2 校正：SMD = -0.15，95% CI（-0.40 至 0.09），p  = 0.22；(iv) 插管率：风险比 (RR) = 0.87，95% CI（0.41 至 1.82），p  = 0.71；(v) 死亡率：RR = 0.85，95% CI（0.47 至 1.56），p  = 0.61；(vi) 治疗转换：RR = 1.30，95% CI（0.43 至 3.94），p  = 0.64。需要进行更多大样本对照试验来研究各种病因的 AHRF 的管理。HFNC 可用作 COPD 相关 AHRF 的最终详尽措施，其中 NIV 不耐受，并且临床上没有表明需要扩展到气管插管。