Efficacy of nasal high-flow therapy versus standard oxygen therapy in hypoxemic respiratory failure: a systematic review and meta-analysis of RCTS.

INTRODUCTION: Respiratory failure is a serious condition caused by impaired gas exchange, leading to hypoxemia or hypercapnia. Nasal high-flow therapy (NHFT) has emerged as an alternative to standard oxygen therapy (SOT). This meta-analysis evaluates the efficacy and safety of NHFT versus SOT by incorporating newly published trials to guide current clinical practice. METHODS: This systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials (RCTs) comparing NHFT with SOT in acute respiratory failure were included. Primary outcomes were mortality and hospital stay. Data were pooled using a random-effects model in RevMan 5.4, and the certainty of evidence was assessed using GRADE. RESULTS: Sixteen RCTs (n = 5805) were included. NHFT showed no significant difference in 28-day mortality [risk ratio (RR) = 1.00; 95% confidence interval (CI): 0.85-1.17] or 90-day mortality (RR = 0.87; 95% CI: 0.58-1.29), length of hospital stay, length of ICU stay, or need for intubation. Oxygen saturation improved with NHFT after sensitivity analysis. Certainty of evidence ranged from moderate to very low using GRADE assessment, with heterogeneity addressed by removing outlier studies. CONCLUSION: NHFT shows comparable safety and efficacy to SOT in acute hypoxemic respiratory failure, with no significant differences in mortality, length of hospital stay, or intubation rates. Oxygen saturation improved with NHFT, reflecting its physiological advantages. Variability in study design limits generalizability. These findings support the individualized use of NHFT. Future research should explore patient-specific benefits, standardize protocols, and assess long-term outcomes.