High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease with Acute Compensated Hypercapnic Respiratory Failure: A Randomized, Controlled Trial

Xu-Yan Li, Xiao Tang, Rui Wang, Xue Yuan, Yu Zhao, Li Wang, Hai-Chao Li, Hui-Wen Chu, Jie Li, Wen-Ping Mao, Yu-Jun Wang, Zhan-Hong Tian, Jian-Hua Liu, Qin Luo, Bing Sun, Zhao-Hui Tong, Xu-Yan Li, Xiao Tang, Rui Wang, Xue Yuan, Yu Zhao, Li Wang, Hai-Chao Li, Hui-Wen Chu, Jie Li, Wen-Ping Mao, Yu-Jun Wang, Zhan-Hong Tian, Jian-Hua Liu, Qin Luo, Bing Sun, Zhao-Hui Tong

Abstract

Introduction: Currently, there is a lack of evidence on the utilization of high-flow nasal cannula (HFNC) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied by hypercapnic respiratory failure. We aimed to explore the efficacy and safety of HFNC compared with conventional oxygen therapy (COT) in such patients.

Methods: This was a prospective, randomized, controlled trial. Patients with AECOPD with a baseline arterial blood gas pH ≥7.35, PaO2 <60 mmHg, and PaCO2 >45 mmHg were enrolled. The primary endpoint was treatment failure, which needs mechanical ventilation.

Results: A total of 320 patients were randomized to either the HFNC group (n = 160) or the COT group (n = 160). Sixteen (10.0%) patients in the HFNC group had treatment failure during hospitalization, which was significantly lower than the COT group figure of 31 (19.4%) patients (p = 0.026). Twenty-four hours after recruitment, the PaCO2 of the HFNC group was lower than that of the COT group (54.1 ± 9.79 mmHg vs 56.9 ± 10.1 mmHg, p = 0.030). PaCO2 higher than 59 mmHg after HFNC for 24 h was identified as an independent risk factor for treatment failure [OR 1.078, 95% CI 1.006-1.154, p = 0.032].

Conclusion: In AECOPD patients with acute compensated hypercapnic respiratory failure, HFNC improved the prognosis compared with COT. Therefore, HFNC might be considered for first-line oxygen therapy in select patients.

Trial registration number: ClinicalTrials.Gov: NCT02439333.

Keywords: chronic obstructive pulmonary disease; conventional oxygen therapy; exacerbation; high-flow nasal cannula; hypercapnic respiratory failure.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2020 Li et al.

Figures

Figure 1
Figure 1
Flow of patients with acute exacerbation of chronic obstructive pulmonary disease through the trial.
Figure 2
Figure 2
Kaplan–Meier estimates of the probability of treatment success at 28 d between the high-flow nasal cannula oxygen therapy (HFNC) group and the conventional oxygen therapy (COT) group. Significant differences were found for the cumulative probability of treatment success for the two groups (Log rank test: p = 0.019).
Figure 3
Figure 3
Comparison of physiological parameters between the high-flow nasal cannula oxygen therapy (HFNC) group and the conventional oxygen therapy (COT) group. Shown are the time courses of partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), arterial oxygen saturation (SaO2), and respiratory rate. pa represents the overall comparison of differences in each group over time, and pb represents overall comparisons of differences between groups over time.
Figure 4
Figure 4
Comparison of physiological parameters between high-flow nasal cannula oxygen therapy success and failure groups. Shown are the time courses of partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), arterial oxygen saturation (SaO2), and respiratory rate. pa represents overall comparisons of differences in each group over time, and pb represents overall comparisons of differences between groups over time.

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Source: PubMed

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