High Flow Nasal Cannula Versus Non-Invasive Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease (HiFOLD)

May 15, 2025 updated by: Unity Health Toronto

High Flow Nasal Cannula Versus Non-Invasive Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease and Hypercapnic Respiratory Failure

Chronic obstructive lung disease is a disabling disease that affects people usually after several years of smoke tobacco exposure and affects millions of patients worldwide. The disease is marked by multiples episode of worsening, termed exacerbations necessitating frequent hospitalizations. During these exacerbations, patients present breathless, and in the most severe cases, are admitted to an Intensive Care Unit (ICU) for respiratory assistance. Currently, respiratory assistance is provided by a ventilator via a oronasal mask (referred to non-invasive ventilation, NIV), that helps patients to cope with their breathless. The mask is not always well tolerated and the ventilator sessions are delivered intermittently. In the past decade, a new technique that provides air-oxygen with high flow has been developed. This technique, called High Flow via Nasal Cannula (HFNC) can deliver from 21 to 100% heated and humidified air-oxygen at a high flow of gas via simple nasal cannula. Recent studies have shown that the technique is very efficient to treat patients presenting with acute respiratory failure who don't have any underlying chronic pulmonary disease. Whether the technique would be also efficient in patients with COLD presenting with severe exacerbations has not yet been demonstrated. Since HFNC does not require any mask, it is thought that the comfort of the patient would be much better in comparison to NIV and could potentially help to treat many patients with the disease. The objective of the present study is to study the physiological effect of HFNC as compared to NIV in patients with severe exacerbations of COPD and to show that it is non-inferior to NIV.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Design: Prospective, observational, cross-over, clinical physiologic study of HFNC and NIV in patients with COPD and hypercapnic respiratory failure Intervention: Participants will be consecutively ventilated with the two devices, i.e., HFNC and NIV. HFNC 30 and 50 L/min will be applied in a random order (sealed, opaque envelope). HFNC will be set with a temperature at 37°C or 34°C if perceived as too warm. NIV settings will be adjusted based on the clinical assessment of the Respiratory Therapist as per standard practice and will not be modified during the test. In both groups, FiO2 will be adjusted to achieve a SpO2 of at least 92%.

Setting: The intervention will be applied in the Medical-Surgical ICU of St. Michael's Hospital.

Duration: Each device will be studied for up to 30 minutes. The entire study will take place over up to 3 hours. There is no additional follow-up thereafter.

Procedures: The study will start first by recording patients under spontaneous breathing considered as a baseline (sequence #1). Under spontaneous breathing, patients will be receiving oxygen therapy as it is usually done between 2 NIV sessions. Then, the patient will have up to 30 minutes to acclimatize to HFNC and select his/her preferred flow rate (sequence #2). NIV will be applied (sequence #3). The NIV settings will be adjusted based on the clinical assessment of the Respiratory Therapist and will not be modified throughout the study. Then, according to randomization order (sealed envelopes), patients will receive a flow corresponding to the preferred flow selected by the patient and a second flow, either HFNC 30 L/min or HFNC 50 L/min depending on the initial choice (sequences #4 and #5) (see flow diagram). FiO2 will be adjusted to achieve a SpO2 of 90 to 94%. Each condition will be studied fup to 30 minutes and will be separated by a 5-minute washout period during which patients will be receiving oxygen therapy. The measurements will be collected at baseline (under spontaneous breathing) and during the last five minutes of each condition. In case of clinical intolerance as considered by the attending physician, the study will stop. In case the patient is considered dependent of NIV by clinicians, we will still enroll the patient without doing baseline period after discussion with clinicians.

The pulse oximeter (SpO2) and transcutaneous CO2 monitor (SenTec Digital Monitoring System (SDMS)) will be continuously monitored throughout the study period. Exspiron or Electrical Impedance Tomography (EIT) device will be calibrated to measure minute ventilation. Four surface electrodes will be placed bilaterally to record each hemidiaphragm activity using a specific recording system (Acqknowledge software, Biopac Systems) A bedside ultrasound examination will be performed, using a SonoSite system (Fujifilm) equipped with a 10-15 MHz ultrasound linear probe. Diaphragm thickness will be measured both at end-inspiration and end-expiration. This technique will be applied at the end of each sequence (before ventilatory assist under conventional O2 therapy). In patients becoming rapidly intolerant to NIV disconnection, we will limit this "baseline" period under O2 to a minimum (5 minutes). The thickness and contraction of the intercostal muscles and abdominal muscles will also be assessed.

Interpretation of the ultrasound results to determine diaphragm and other muscle thickness will be read at a later time by an individual blinded to the intervention.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Laurent Brochard, MD
  • Phone Number: +1 416 864 5686
  • Email: BrochardL@smh.ca

Study Contact Backup

  • Name: Martin Dres, MD
  • Phone Number: +1 416 692 7420
  • Email: DresM@smh.ca

Study Locations

  • Canada
    • Ontario
      • Toronto, Ontario, Canada, M5B 1W8
        • Recruiting
        • St. Michael's Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

36 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. COPD exacerbation and acute hypercapnic respiratory failure with acute respiratory failure defined by

    • Respiratory acidosis (pH ≤7.35 and PaCO2 ≥45 mmHg);
    • Respiratory rate≥20 breaths/min;
    • Activation of accessory respiratory muscles;
  2. Undergone at NIV or HFNC since their admission
  3. English speaking
  4. Adult patient with age > 40 year old.

Exclusion Criteria:

  1. Severe respiratory acidosis defined by pH<7.25
  2. Decreased level of consciousness (Glasgow Coma Score Scale < 11)
  3. Urgent intubation required
  4. Pneumothorax with pleural drainage and persistent air leak
  5. Hemodynamic instability requiring vasopressors
  6. Uncooperative
  7. Patients with skin or chest wall or abdominal trauma (potentially worsened by placement of a surface sensor)
  8. Clinical judgement of the attending physician
  9. Body mass index > 40 kg/m2

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Non invasive ventilation
Patients will receive non invasive ventilation with setting decided by the attending physician.
Device: Non Invasive Ventilation
Patients will receive non invasive ventilation as a standard of care.
Other Names:
  • Standard of Care
Active Comparator: High Flow 50 L/min
High Flow Oxygen Cannula with a flow set at 50 L/min.
Device: High Flow Oxygen Cannula 50
Patients will receive High Flow Oxygen Cannula with a flow set at 50 L/min
Other Names:
  • HFNO 50
Active Comparator: High Flow 30 L/min
High Flow Oxygen Cannula with a flow set at 30 L/min.
Device: High Flow Oxygen Cannula 30
Patients will receive High Flow Oxygen Cannula with a flow set at 30 L/min
Other Names:
  • HFNO 30

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in work of breathing between NIV and HFNC
Time Frame: 30 minutes

The primary endpoint is to compare the decrease in work of breathing under HFNC to the decrease in work of breathing under NIV.

The work of breathing will be assessed with diaphragm ultrasound (measurement of the diaphragm thickening fraction).
30 minutes

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in Work of breathing between HFNC 50 and 30 L/min
Time Frame: 30 minutes

The secondary endpoints include comparison of the work of breathing under HFNC (50L/min vs 30 L/min).

The work of breathing will be assessed with diaphragm ultrasound (measurement of the diaphragm thickening fraction).
30 minutes

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Unity Health Toronto

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 2, 2018

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 11, 2025

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 1, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
January 19, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 24, 2017

First Posted (Estimated)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
January 26, 2017

Study Record Updates

Last Update Posted (Estimated)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
May 20, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 15, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
May 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • REB# 16-389

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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Conditions

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