Respiratory failure & ventilation
Non-invasive respiratory supports and criteria for intubation in randomised trials of acute hypoxaemic respiratory failure: a systematic review and network meta-analysis
Authors' conclusion
Compared with SOT, CPAP, HFNC, and bilevel NIPPV probably reduce intubation, and CPAP and HFNC may reduce mortality. Criteria for intubation were common but were not associated with differences in treatment efficacy.
Study context
- Population
- Adults (≥18 years) with acute hypoxaemic respiratory failure (AHRF)
- Participants
- 9,704 adults · 44 trials
- Comparison
- Continuous positive airway pressure (CPAP), high-flow nasal cannula (HFNC) and bilevel non-invasive positive pressure ventilation (NIPPV) vs standard oxygen therapy (SOT); effect of intubation criteria
- Outcome
- Intubation and mortality
Methodological detailsnetwork meta-regression, pre-registered protocol, GRADE certainty
- Network meta-regression
- Pre-registered protocol
- GRADE certainty
Pooled result
As reported in the abstract
Intubation
Each group vs SOTOdds ratio (95% CrI)
CPAP
0.45(0.27–0.72)
HFNC
0.61(0.42–0.86)
Bilevel NIPPV
0.60(0.39–0.89)
Further pooled results
| Outcome | OR (95% CrI) | |
|---|---|---|
| MortalityCPAP vs SOT · CrI; low certainty · CrI | 0.73 (0.55–0.95) | |
| MortalityHFNC vs SOT · CrI; low certainty · CrI | 0.83 (0.66–0.98) | |
| MortalityBilevel NIPPV vs SOT · CrI; low certainty · CrI | 0.93 (0.71–1.17) | |
| 0.512Odds ratio (log scale) |
- Mortality: 8789 patients, 34 trials
Intubation criteria and treatment effects (network meta-regression)
- Intubation criteria present in trials
- 37 (84%)
- Criteria for intubation not associated with differences in treatment effects
Original publication
Non-invasive respiratory supports and criteria for intubation in randomised trials of acute hypoxaemic respiratory failure: a systematic review and network meta-analysis. Lancet Respir Med. Published 22 April 2026. doi:10.
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