High Flow Nasal Cannulas have a significant impact in the management of ARDS in COVID-19 patients : A Systematic Review

Dimas Hadi Prayoga, Natalia Christin Tiara Revita, Devy Syanindita Roshida, Eska Distia Permatasari


ARDS or Acute Respiratory Distress Syndrome defines a clinical condition of severe lung disease associated with pneumonia, sepsis and trauma which can be caused by SARS-Cov-2 or COVID-19. COVID-19-induced ARDS has a high mortality rate. The choice of mechanical ventilation is very important so that it can be used as appropriate treatment for ARDS caused by COVID-19, so it is necessary to review journals to obtain information related to preventing an increase in ARDS cases in COVID-19. A search strategy relevant to the study topic was carried out using the databases "Scopus, PubMed, Science Direct, EBSCO and Pro Quest". The keywords used were "ARDS", "HFNC", "NIV", and "Mechanical Ventilation". Full-text articles and abstracts were reviewed to select themes that met the criteria. Articles or journals use randomized controlled trials. Minimum intervention month duration. Or journal articles published from January 2017 to September 2022. Evidence of relative effectiveness was found that HFNC was more effective than NIV. There were seven articles that described HFNC relegating patients to intubation. All articles were analyzed using Randomized Controlled Trials (RCT). Patients treated with HFNC showed better outcomes compared with NIV for COVID-19. Therefore, HFNC should be considered before NIV in COVID-19. However, further research with a larger sample size is still needed to better explain the benefits of HFNC in COVID-19 patients.

Keywords: Acute Respiratory Distres Syndrome; COVID-19,  High Flow Nasal Canula; Mechanical Ventilation/ Non Invasive Ventilation


Grasselli G, Tonetti T, Protti A, Langer T, Girardis M, Bellani G, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med. 2020;8(12):1201–8.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–43.

Estenssoro E, Loudet CI, Dubin A. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19 . The COVID-19 resource centre is hosted on Elsevier Connect , the company ’ s public news and information . 2020;(January).

Fatoni AZ, Rakhmatullah R. Acute Respiratory Distress Syndrome (ARDS) pada Pneumonia COVID-19. J Anaesth Pain. 2021;2(1):11–24.

Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Crit Care. 2020;24(1):1–3.

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of covid-19. Viruses. 2020;12(4):1–17.

Wang Z, Wang Y, Yang Z, Wu H, Liang J, Liang H, et al. The use of non-invasive ventilation in COVID-19: A systematic review. Int J Infect Dis [Internet]. 2021;106:254–61. Available from: https://doi.org/10.1016/j.ijid.2021.03.078

Xie J, Wang Z, Liang J, Lin H, Yang Z, Wang Y, et al. Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines. Open Forum Infect Dis. 2021;8(8):1–13.

Rochwerg B, Granton D, Wang DX, Helviz Y, Einav S, Frat JP, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med [Internet]. 2019;45(5):563–72. Available from: https://doi.org/10.1007/s00134-019-05590-5

Azoulay E, Lemiale V, Mokart D, Nseir S, Argaud L, Pène F, et al. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients with Acute Respiratory Failure: The HIGH Randomized Clinical Trial. JAMA - J Am Med Assoc. 2018;320(20):2099–107.

Zhiling Z, Hong C, Qin C, Nan L, Shuisheng Z, Qinggang G, et al. Effect of noninvasive positive pressure ventilation and high-flow nasal cannula oxygen therapy on the clinical efficacy of coronavirus disease 2019 patients with acute respiratory distress syndrome. Chinese Crit Care Med. 2021;33(6):708–13.

L S, Sehgal IS, Kajal K, Kataria S, Premkumar M, Singla K, et al. Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India. Cureus. 2022;14(9).

Kerai S, Singh R, Saxena KN, Desai SD, Bhalotra AR. A Retrospective Study on Experience of High-flow Nasal Cannula Oxygen in Critically Ill COVID-19 Adult Patients Admitted to Intensive Care Unit. Indian J Crit Care Med. 2022;26(1):62–6.

Procopio G, Cancelliere A. Oxygen therapy via high flow nasal cannula in severe respiratory failure caused by Sars- Cov-2 infection: a real-life observational study. Ther Adv Vaccines. 2022;9(6):259–61.

Isaac BTJ, Priya N, Nair AA, Thangakunam B, Balachandran A, George T, et al. Treatment of COVID-19 Acute Respiratory Distress Syndrome With a Tabletop Noninvasive Ventilation Device in a Respiratory Intermediate Care Unit. Mayo Clin Proc Innov Qual Outcomes [Internet]. 2022;6(3):239–49. Available from: https://doi.org/10.1016/j.mayocpiqo.2022.04.001

Carpagnano GE, Buonamico E, Migliore G, Resta E, Di Lecce V, de Candia ML, et al. Bilevel and continuous positive airway pressure and factors linked to all-cause mortality in COVID-19 patients in an intermediate respiratory intensive care unit in Italy. Expert Rev Respir Med [Internet]. 2021;15(6):853–7. Available from: https://doi.org/10.1080/17476348.2021.1866546

Bonnet N, Martin O, Boubaya M, Levy V, Ebstein N, Karoubi P, et al. High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study. Ann Intensive Care [Internet]. 2021;11(1):1–9. Available from: https://doi.org/10.1186/s13613-021-00825-5

Schmidt M, Demoule A, Hajage D, Pham T, Combes A, Dres M, et al. Benefits and risks of noninvasive oxygenation strategy in COVID-19: a multicenter, prospective cohort study (COVID-ICU) in 137 hospitals. Crit Care. 2021;25(1):1–13.

Wendel Garcia PD, Aguirre-Bermeo H, Buehler PK, Alfaro-Farias M, Yuen B, David S, et al. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort. Crit Care. 2021;25(1):1–12.

Mellado-Artigas R, Ferreyro BL, Angriman F, Hernández-Sanz M, Arruti E, Torres A, et al. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Crit Care [Internet]. 2021;25(1):1–10. Available from: https://doi.org/10.1186/s13054-021-03469-w

Sayan İ, Altınay M, Çınar AS, Türk HŞ, Peker N, Şahin K, et al. Impact of HFNC application on mortality and intensive care length of stay in acute respiratory failure secondary to COVID-19 pneumonia. Hear Lung. 2021;50(3):425–9.

Wang K, Zhao W, Li J, Shu W, Duan J. The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China. Ann Intensive Care. 2020;10(1):0–4.

Duan J, Chen B, Liu X, Shu W, Zhao W, Li J, et al. Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study. 2020;(January).

Xia J, Zhang Y, Ni L, Chen L, Zhou C, Gao C, et al. High-Flow Nasal Oxygen in Coronavirus Disease 2019 Patients With Acute Hypoxemic Respiratory Failure: A Multicenter, Retrospective Cohort Study∗. Crit Care Med. 2020;48(11):E1079–86.

Agarwal R, Reddy C, Aggarwal AN, Gupta D. Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis. Respir Med. 2006;100(12):2235–8.

Tasaka S, Ohshimo S, Takeuchi M, Yasuda H, Ichikado K, Tsushima K, et al. ARDS clinical practice guideline 2021. Respir Investig. 2022;60(4):446–95.

Salcin S, Fontem F. Recurrent SARS-CoV-2 infection resulting in acute respiratory distress syndrome and development of pulmonary hypertension: A case report. Respir Med Case Reports [Internet]. 2021;33:101314. Available from: https://doi.org/10.1016/j.rmcr.2020.101314

DOI: http://dx.doi.org/10.33846/sf.v15i2.3912


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