DOI: https://doi.org/10.36347/sjams.2026.v14i05.028

Pages: 813-817

Introduction: Extubation failure remains a common complication in critically ill patients and is associated with increased mortality, prolonged intensive care unit (ICU) stay, and higher healthcare costs. High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) are widely used after extubation to prevent post-extubation respiratory failure, but their comparative effectiveness remains debated. Objective: To compare the effectiveness of HFNO versus NIV after extubation in critically ill adult patients regarding reintubation and major clinical outcomes. Methods: A systematic review and meta-analysis was conducted according to PRISMA recommendations. PubMed, Scopus, Embase, and Cochrane Library were searched for studies published between 2010 and 2026 comparing HFNO and NIV after extubation in adult ICU patients. Randomized controlled trials and comparative observational studies were included. The primary outcome was reintubation rate. Secondary outcomes included post-extubation respiratory failure, ICU mortality, hospital mortality, ICU length of stay, and patient comfort. Results: Several randomized controlled trials and observational studies were included. Hernández et al., randomized 604 high-risk ICU patients and demonstrated noninferiority of HFNO compared with NIV regarding reintubation prevention. Thille et al., reported reintubation rates of 11.8% with NIV combined with HFNO versus 18.2% with HFNO alone in 641 high-risk patients. HFNO was consistently associated with improved patient comfort and better tolerance. In hypercapnic and very high-risk patients, NIV remained associated with lower rates of post-extubation respiratory failure in several studies. Conclusion: HFNO represents an effective alternative to NIV after extubation in critically ill patients and may provide better comfort and tolerance. NIV may still remain preferable in selected high-risk populations. Further large multicenter randomized studies are needed to better define optimal post-ex