Respiratory failure & ventilation
High-Flow Nasal Oxygen and the Risk of Gastric Insufflation: A Systematic Review and Meta-Analysis Supplemented by Narrative Synthesis
Pooled result · Gastric insufflation, elective peri-intubationResult — go to the resultRelative risk 0.32 95% CI 0.19–0.52Authors' conclusion
Moderate-certainty evidence supports HFNO as safe regarding gastric insufflation and antral cross-sectional area in most elective and procedural contexts.
Study context
- Population
- Studies reporting markers of gastric insufflation during high-flow nasal oxygen (HFNO) use across clinical settings (randomized controlled trials (RCTs), observational and volunteer studies, case reports)6 RCTs, 5 observational studies, other designs
- Comparison
- HFNO vs face-mask ventilation
- Outcome
- Gastric insufflation
Methodological detailsGrading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty rating, Mixed Methods Appraisal Tool, Medline, Embase, Emcare, CINAHL searched through August 2025
- GRADE certainty rating
- Mixed Methods Appraisal Tool
- Medline, Embase, Emcare, CINAHL searched through August 2025
Pooled result
Gastric insufflation, elective peri-intubation
Relative risk
0.32
95% CI 0.19–0.52
P < 0.00001
HFNO vs Face-mask ventilation
RR 0.32 (95% CI 0.19–0.52); P < 0.00001
As reported in the abstract
Further pooled results
| Outcome | MD (cm 2) (95% CI) | P value | |
|---|---|---|---|
| Antral cross-sectional area (RCTs)3 RCTs, n = 318; I 2 = 74% · moderate-certainty | −0.33 (−0.72 to 0.05) | P = 0.09 | |
| Antral cross-sectional area, pre vs post HFNO (observational studies)I 2 = 0% · low certainty | 0.08 (−0.29 to 0.45) | P = 0.67 | |
| −1−0.500.5Difference, cm 2 (linear scale) |
| Outcome | MD (ml/kg) (95% CI) | P value | |
|---|---|---|---|
| Gastric liquid volume, pre vs post HFNO (observational studies)I 2 = 0% · low certainty | −0.01 (−0.07 to 0.06) | P = 0.80 | |
| −0.1−0.0500.050.1Difference, ml/kg (linear scale) |
Critically ill patients (nonpooled)
- Possible increases in critically ill patients; very low certainty
Safety
Microaspiration and gastroesophageal reflux (single study)
- HFNO reduced gastroesophageal reflux and prevented microaspiration vs face-mask ventilation
Clinically significant aspiration events
- No clinically significant aspiration events reported across studies
Original publication
High-Flow Nasal Oxygen and the Risk of Gastric Insufflation: A Systematic Review and Meta-Analysis Supplemented by Narrative Synthesis. Anesth Analg. Published 4 March 2026. doi:10.
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