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This systematic review and meta\u2010analysis aimed to determine the effect of HFNC versus NIV on AHRF management. A search of electronic databases (CINAHL, MEDLINE, and Academic Search Complete), web sources, and trial registries was last conducted on 9 February 2023. Quality and risk of bias assessments were conducted. Meta\u2010analyses were used to synthesise data. Seven randomised controlled trials were included. No statistically significant differences between HFNC and NIV were found within the following outcomes of interest: (i) correction of pCO2: standardised mean difference (SMD)\u2009=\u2009\u22120.16, 95% confidence interval (CI) (\u22120.34 to 0.02), <jats:italic>p<\/jats:italic>\u2009=\u20090.08; (ii) correction of pH: SMD\u2009=\u2009\u22120.05, 95% CI (\u22120.25 to 0.14), <jats:italic>p<\/jats:italic>\u2009=\u20090.59; (iii) correction of pO2: SMD\u2009=\u2009\u22120.15, 95% CI (\u22120.40 to 0.09), <jats:italic>p<\/jats:italic>\u2009=\u20090.22; (iv) intubation rates: risk ratio (RR)\u2009=\u20090.87, 95% CI (0.41 to 1.82), <jats:italic>p<\/jats:italic>\u2009=\u20090.71; (v) mortality rates: RR\u2009=\u20090.85, 95% CI (0.47 to 1.56), <jats:italic>p<\/jats:italic>\u2009=\u20090.61; and (vi) treatment switch: RR\u2009=\u20091.30, 95% CI (0.43 to 3.94), <jats:italic>p<\/jats:italic>\u2009=\u20090.64. More controlled trials with large sample sizes are required to investigate the management of AHRF of various aetiologies. HFNC may be used as a final exhaustive measure for COPD\u2010related AHRF where NIV is not tolerated, and when it is not clinically indicated to extend to endotracheal intubation.<\/jats:p>","DOI":"10.1111\/crj.13695","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T06:15:20Z","timestamp":1694585720000},"page":"1091-1102","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["High flow nasal cannula versus noninvasive ventilation in the treatment of acute hypercapnic respiratory failure: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"17","author":[{"given":"Aisling C.","family":"Fahey","sequence":"first","affiliation":[{"name":"Catherine McAuley School of Nursing and Midwifery University College Cork  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Catherine McAuley School of Nursing and Midwifery University College Cork  Cork Ireland"},{"name":"Kerry Mental Health Services, Cork\/Kerry Community Healthcare Health Service Executive  Tralee Co. Kerry Ireland"},{"name":"Health Service Executive National eRostering Project, Community Healthcare Operations Improvement and Change St. Loman's Hospital  Lucan Co. Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Cornally","sequence":"additional","affiliation":[{"name":"Catherine McAuley School of Nursing and Midwifery University College Cork  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7277-6268","authenticated-orcid":false,"given":"Mohamad M.","family":"Saab","sequence":"additional","affiliation":[{"name":"Catherine McAuley School of Nursing and Midwifery University College Cork  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00038503"},{"key":"e_1_2_12_3_1","volume-title":"The Respiratory System at a Glance","author":"Ward JPT","year":"2015"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp\u20102016\u2010000133"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.153114"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02426\u20102016"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp\u20102018\u2010000283"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.10.819"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010015\u20104087\u20104"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010004\u20102320\u20107"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet070"},{"issue":"1","key":"e_1_2_12_12_1","first-page":"71","article-title":"Interfaces and humidification for noninvasive mechanical ventilation","volume":"54","author":"Nava S","year":"2009","journal-title":"Respir Care"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03075"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06931"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pulmoe.2019.08.001"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010020\u201006312\u2010y"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.4046\/trd.2015.78.4.455"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00934.2014"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.3639"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2017.12.006"},{"key":"e_1_2_12_21_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.3","author":"Higgins JPT","year":"2022"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/ACPJC\u20101995\u2010123\u20103\u2010A12"},{"key":"e_1_2_12_24_1","volume-title":"Roy Rosenzweig Center for History and New Media","author":"Corporation for Digital Scholarship","year":"2023"},{"key":"e_1_2_12_25_1","unstructured":"Veritas Health Innovation.Better systematic review management.2023. 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