{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:56:47Z","timestamp":1765875407005,"version":"3.48.0"},"reference-count":25,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T00:00:00Z","timestamp":1581379200000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009965","name":"American College of Physicians","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009965","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,12,16]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>High-flow nasal oxygen (HFNO) use in adults hospitalised with acute respiratory failure (ARF) is increasing. However, evidence to support widespread use of HFNO compared with non-invasive ventilation (NIV) and conventional oxygen therapy (COT) is unclear. This protocol describes the methods for a systematic evidence review regarding the comparative effectiveness and harms of HFNO compared with NIV or COT for the management of ARF in hospitalised adult patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We will search MEDLINE, Embase, CINAHL and Cochrane Library for randomised-controlled trials (RCTs) of adult patients hospitalised with ARF or who developed ARF while hospitalised. ARF will be defined as SpO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;90%, PaO\n                      <jats:sub>2<\/jats:sub>\n                      :FiO\n                      <jats:sub>2<\/jats:sub>\n                      ratio \u2264300, PaO\n                      <jats:sub>2<\/jats:sub>\n                      \u226460\u2009mm Hg, or PaCO\n                      <jats:sub>2<\/jats:sub>\n                      \u226545\u2009mm Hg. The intervention is HFNO (humidified oxygen, flow rate \u226520\u2009L\/min) compared separately to NIV or COT. The critical outcomes are: all-cause mortality, hospital-acquired pneumonia, intubation\/reintubation (days of intubation), intensive care unit admission\/transfers, patient comfort and hospital length of stay. The important outcomes are: delirium, 30-day hospital readmissions, barotrauma, compromised nutrition (enteral or parenteral nutrition), gastric dysfunction, functional independence at discharge and skin breakdown or pressure ulcers. We will calculate risk ratios and Peto ORs (for rare events) and corresponding 95% CIs for categorical outcomes. Mean and standardised mean difference will be calculated for continuous outcomes. Where possible and appropriate, meta-analysis will be performed for each outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review will provide a comprehensive evaluation of the evidence regarding the comparative effectiveness and harms of HFNO compared with NIV or COT for the management of ARF in hospitalised adult patients to inform clinical practice and to identify research gaps in the management of ARF in hospitalised adults. The results will inform the work of the American College of Physicians-Clinical Guidelines Committee in their development of a clinical guideline related to use of HFNO in adult patients with ARF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>No ethical approval will be needed because we will be using data from previously published studies in which informed consent was obtained by the primary investigators. We will publish our results in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42019146691<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034956","type":"journal-article","created":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T09:19:37Z","timestamp":1581499177000},"page":"e034956","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Effectiveness and harms of high-flow nasal oxygen (HFNO) for acute respiratory failure: a systematic review protocol"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8309-0747","authenticated-orcid":false,"given":"Arianne K","family":"Baldomero","sequence":"first","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Melzer","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA"},{"name":"Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy","family":"Greer","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany N","family":"Majeski","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roderick","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J","family":"Wilt","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA"},{"name":"Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,12]]},"reference":[{"key":"2025121600534480000_10.2.e034956.1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.tacc.2019.02.001","article-title":"Physiopathological rationale of using high-flow nasal therapy in the acute and chronic setting: a narrative review","volume":"26-27","author":"Spoletini","year":"2019","journal-title":"Trends in Anaesthesia and Critical Care"},{"key":"2025121600534480000_10.2.e034956.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12871-018-0623-4","article-title":"High flow nasal therapy in perioperative medicine: from operating room to general ward","volume":"18","author":"Cortegiani","year":"2018","journal-title":"BMC Anesthesiol"},{"key":"2025121600534480000_10.2.e034956.3","first-page":"408","article-title":"High-flow oxygen therapy in acute respiratory failure","volume":"55","author":"Roca","year":"2010","journal-title":"Respir Care"},{"key":"2025121600534480000_10.2.e034956.4","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02397"},{"key":"2025121600534480000_10.2.e034956.5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s13054-019-2473-y","article-title":"Effect of high-flow nasal therapy on dyspnea, comfort, and respiratory rate","volume":"23","author":"Cortegiani","year":"2019","journal-title":"Crit Care"},{"key":"2025121600534480000_10.2.e034956.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2009.06.050"},{"key":"2025121600534480000_10.2.e034956.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2011.07.075"},{"key":"2025121600534480000_10.2.e034956.8","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199611000-00025"},{"key":"2025121600534480000_10.2.e034956.9","doi-asserted-by":"publisher","DOI":"10.1177\/1479972307087190"},{"key":"2025121600534480000_10.2.e034956.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-011-2354-6"},{"key":"2025121600534480000_10.2.e034956.11","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01575"},{"key":"2025121600534480000_10.2.e034956.12","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00584.2016"},{"key":"2025121600534480000_10.2.e034956.13","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1177\/0310057X1103900620","article-title":"Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures","volume":"39","author":"Ritchie","year":"2011","journal-title":"Anaesth Intensive Care"},{"key":"2025121600534480000_10.2.e034956.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05536.x"},{"key":"2025121600534480000_10.2.e034956.15","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02358"},{"key":"2025121600534480000_10.2.e034956.16","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01106"},{"key":"2025121600534480000_10.2.e034956.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2007.08.001"},{"key":"2025121600534480000_10.2.e034956.18","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep280"},{"key":"2025121600534480000_10.2.e034956.19","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer265"},{"key":"2025121600534480000_10.2.e034956.20","doi-asserted-by":"crossref","first-page":"863","DOI":"10.7326\/M18-3290","article-title":"The development of clinical guidelines and guidance statements by the clinical guidelines Committee of the American College of physicians: update of methods","volume":"170","author":"Qaseem","year":"2019","journal-title":"Ann Intern Med"},{"key":"2025121600534480000_10.2.e034956.21","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2025121600534480000_10.2.e034956.22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1187"},{"key":"2025121600534480000_10.2.e034956.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"2025121600534480000_10.2.e034956.24","unstructured":"McMaster University and Evidence Prime, Inc . GRADEpro GDT: GRADEpro Guideline development tool. Ontario, Canada, 2015."},{"key":"2025121600534480000_10.2.e034956.25","unstructured":"Sch\u00fcnemann H , Bro\u017cek J , Guyatt G , et al . GRADE Handbook, 2019. Available: https:\/\/gdt.gradepro.org\/app\/handbook\/handbook.html [Accessed 9 Oct 2019]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-034956","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:53:54Z","timestamp":1765875234000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-034956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2,12]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/bmjopen-2019-034956"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-034956","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}