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Heated Humidified High Flow Oxygen for Respiratory Support: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: November 13, 2019
Project Number: RC1066-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of heated humidified high flow oxygen in hospital and during transfers?
  2. What is the cost-effectiveness of heated humidified high flow oxygen compared with other respiratory support?
  3. What are the evidence-based guidelines for use of heated humidified high flow oxygen in hospital and during patient transfers?

Key Message

There are a substantial number of studies assessing heated, humidified high flow oxygen. The evidence suggests that heated, humidified high flow oxygen. may help to avert the need for intubation relative to conventional oxygen therapy or non-invasive ventilation, though the findings were not consistent. The evidence does not suggest that the length of hospitals stays or oxygenation outcomes are better with high flow oxygen relative to conventional oxygen therapy or non-invasive ventilation. Patient comfort outcomes were not systematically studied, but may be improved with heated high flow oxygen. No included study assessed the intervention during hospital transfers, and studies of non-neonatal pediatric patients were limited in both quality and quantity.Heated, humidified high flow oxygen may be both less costly and more effective to avert intubations, however this was based on one UK-based cost-effectiveness analysis.No relevant evidence-based guidelines on the use of heated, humidified high flow oxygen were identified. The systematic reviews retrieved in this review generally had a low risk of bias, however the clinical trials were more mixed. The main risks of bias in the clinical trials stemmed from small sample sizes, unclear primary outcomes, and lack of blinding.