HIGH-FLOW NASAL CANNULA VERSUS NONINVASIVE VENTILATION IN IMMUNOCOMPROMISED PATIENTS WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE: A SYSTEMATIC REVIEW BETWEEN PULMONOLOGY AND INTENSIVE CARE
DOI:
https://doi.org/10.56238/levv17n61-032Keywords:
Respiratory Insufficiency, Immunocompromised Host, High-Flow Nasal Cannula, Noninvasive VentilationAbstract
Introduction: Acute hypoxemic respiratory failure is a frequent and high-risk complication in immunocompromised patients, particularly among individuals with hematologic malignancy, solid organ transplantation, neutropenia, chemotherapy exposure, prolonged corticosteroid therapy, or other forms of clinically relevant immunosuppression. High-flow nasal cannula and noninvasive ventilation are commonly used to avoid endotracheal intubation, but their comparative effectiveness remains uncertain in this population. Objective: This systematic review aimed to compare high-flow nasal cannula with noninvasive ventilation in immunocompromised patients with acute hypoxemic respiratory failure. Secondary objectives included evaluation of intubation, mortality, treatment failure, adverse events, comfort, tolerance, and factors influencing clinical selection between both strategies. Methods: A structured search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Eligible studies included adult or mixed adult clinical populations with immunocompromise and acute hypoxemic respiratory failure treated with high-flow nasal cannula, noninvasive ventilation, or both. Randomized trials, post hoc analyses, prospective cohorts, and retrospective comparative studies were considered. Risk of bias was assessed using RoB 2 or ROBINS-I according to study design, and certainty of evidence was judged using GRADE. Results and Discussion: Seven studies were included in the final qualitative synthesis. Earlier post hoc and observational studies suggested lower intubation or mortality signals with high-flow nasal cannula compared with noninvasive ventilation, whereas later randomized evidence did not demonstrate mortality benefit from routinely adding noninvasive ventilation to high-flow nasal oxygen. The RENOVATE trial broadened the evidence base but did not definitively resolve the immunocompromised hypoxemic subgroup. Overall, high-flow nasal cannula appears to be a reasonable first-line strategy for many immunocompromised patients with de novo hypoxemia, while noninvasive ventilation should be reserved for selected phenotypes with a plausible physiological benefit from positive pressure. Conclusion: High-flow nasal cannula should be considered a preferred initial strategy in many immunocompromised patients with acute hypoxemic respiratory failure when close monitoring and early escalation are available. Noninvasive ventilation remains useful in selected patients but should not be applied routinely without clear physiological indication and predefined failure criteria.
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