Respiratory failure & ventilation
Physiological effects of noninvasive respiratory support strategies in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis
Authors' conclusion
Noninvasive strategies exert distinct physiological effects: HFNO and NIV reduce effort per minute, while only NIV decreases effort per breath but at the cost of increased driving pressure. CPAP has neutral effects on driving pressure and effort. CPAP and NIV provide greater improvements in oxygenation than HFNO.
Study context
- Population
- Adults with acute hypoxemic respiratory failure (mean PaO2/FiO2 131 (± 48) mmHg)
- Participants
- 312 adults · 13 studies
- Comparison
- High-flow nasal oxygen (HFNO), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP) vs standard oxygen
- Outcome
- Transpulmonary driving pressure and inspiratory effort
Methodological detailsesophageal manometry
- Esophageal manometry
Pooled result
As reported in the abstract
Each group vs standard oxygenMD, cmH2O*bpm (95% CI)
HFNOeffort per minute
−95(−140 to −49)
NIVeffort per minute
−240(−284 to −196)
Each group vs standard oxygenMD, cmH2O (95% CI)
NIVeffort per breath
−5.9(−7.4 to −4.4)
Each group vs standard oxygenMD, cmH₂O (95% CI)
NIVdriving pressure
3.4(1.4–5.4)
Further pooled results
| Outcome | MD (breaths*min-1) (95% CI) | |
|---|---|---|
| Respiratory rateHFNO vs Standard oxygen | −5 (−6 to −4) | |
| Respiratory rateCPAP vs Standard oxygen | −2 (−4 to −1) | |
| Respiratory rateNIV vs Standard oxygen | −4 (−5 to −2) | |
| −10−505Difference, breaths*min-1 (linear scale) |
| Outcome | MD (mmHg) (95% CI) | |
|---|---|---|
| PaO2/FiO2CPAP vs Standard oxygen | 67 (55–80) | |
| PaO2/FiO2NIV vs Standard oxygen | 82 (56–108) | |
| PaO2/FiO2HFNO vs Standard oxygen | 24 (5–43) | |
| −50050100150Difference, mmHg (linear scale) |
PaCO2
- None of the strategies affected PaCO2
Original publication
Physiological effects of noninvasive respiratory support strategies in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis. Crit Care. Published 28 October 2025. doi:10.
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