Lin C, Song KR, Li QH, Nair GS, Cheng S, Kumar K. High-flow nasal cannula for hypoxia in the post-anesthetic recovery unit: A systematic review and meta-analysis. World J Crit Care Med 2026; 15(2): 118285 [PMID: 42272891 DOI: 10.5492/wjccm.v15.i2.118285]
Corresponding Author of This Article
Cheng Lin, Associate Professor, FRCPC, Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine, Western University, University Hospital, No. 800 Commissioners Road East, London, ON N6A 5A5, Canada. cheng.lin@lhsc.on.ca
Research Domain of This Article
Anesthesiology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Lin C, Song KR, Li QH, Nair GS, Cheng S, Kumar K. High-flow nasal cannula for hypoxia in the post-anesthetic recovery unit: A systematic review and meta-analysis. World J Crit Care Med 2026; 15(2): 118285 [PMID: 42272891 DOI: 10.5492/wjccm.v15.i2.118285]
World J Crit Care Med. Jun 9, 2026; 15(2): 118285 Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.118285
High-flow nasal cannula for hypoxia in the post-anesthetic recovery unit: A systematic review and meta-analysis
Cheng Lin, Kevin R Song, Qing Hao Li, Gopakumar S Nair, Sonny Cheng, Kamal Kumar
Cheng Lin, Kevin R Song, Qing Hao Li, Gopakumar S Nair, Sonny Cheng, Kamal Kumar, Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine, Western University, London, ON N6A 5A5, Canada
Author contributions: Lin C contributed to design and implementation of the study, statistical analysis, and writing of the manuscript; Song KR and Li QH contributed to acquisition of data and writing of the manuscript; Nair GS and Cheng S contributed to design and implementation of the study and revision of the manuscript; Kumar K contributed to quality and professional revision.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Cheng Lin, Associate Professor, FRCPC, Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine, Western University, University Hospital, No. 800 Commissioners Road East, London, ON N6A 5A5, Canada. cheng.lin@lhsc.on.ca
Received: December 29, 2025 Revised: January 25, 2026 Accepted: February 24, 2026 Published online: June 9, 2026 Processing time: 144 Days and 2.2 Hours
Abstract
BACKGROUND
Earlier meta-analyses demonstrated conflicting results on whether high-flow nasal cannula (HFNC) reduces rate of intubation in the postoperative period when compared to conventional oxygen therapy (COT). Since then, newer studies have come out, so an updated comparison of these two modalities is warranted.
AIM
To determine whether HFNC reduces the rate of reintubation compared to COT.
METHODS
We conducted a random-effects meta-analysis, searching databases (MEDLINE, EMBASE, Web of Science) to identify randomized controlled trials comparing HFNC with COT on postoperative patient outcomes of interest including reintubation, escalation to noninvasive ventilation, mortality, length of stay, pneumonia, postoperative pulmonary complications, vital signs and blood gas measurements. We assessed the quality of data using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS
Twenty-five trials, including 4260 patients met the inclusion criteria. Thirteen investigated reintubation and the pooled result was not significant [odds ratio (OR); 0.93; 95% confidence interval (CI): 0.36-2.38; I2 = 47.1%; P = 0.86]. However, HFNC reduced the incidence of atelectasis (OR 0.33; 95%CI: 0.18-0.59; I2 = 10.8%; P = 0.0046) and hypoxemia (OR 0.42; 95%CI: 0.21-0.83; I2 = 78.3%; P = 0.017). There were no clinical differences detected in other outcomes. GRADE for certainty of evidence was low to moderate.
CONCLUSION
HFNC does not reduce reintubation risk in our analysis with moderate certainty. Use of HFNC should not delay escalation of therapy to noninvasive ventilation or a definitive airway.
Core Tip: High-flow nasal cannula has beneficial effect on prevention of atelectasis and hypoxemia compared to conventional oxygen therapy. However, it does not reduce the risk of clinical outcomes including reintubation, therapy escalation, pneumonia, postoperative pulmonary complication, mortality, or prolonged hospital or intensive care unit stay.
