Efficacy and safety of nasal high-flow oxygen in COPD patients

Helene Vogelsinger, Michael Halank, Silke Braun, Heinrike Wilkens, Thomas Geiser, Sebastian Ott, Armin Stucki, Christian M Kaehler, Helene Vogelsinger, Michael Halank, Silke Braun, Heinrike Wilkens, Thomas Geiser, Sebastian Ott, Armin Stucki, Christian M Kaehler

Abstract

Background: Nasal high-flow oxygen therapy (HFOT) is a novel treatment option for patients suffering from acute or chronic respiratory failure. Aim of our study was to compare safety and efficacy of HFOT with those of conventional oxygen treatment (COT) in normo- and hypercapnic COPD patients.

Methods: A single cohort of 77 clinically stable hypoxemic patients with an indication for long-term oxygen treatment (LTOT) with or without hypercapnia successively received COT and HFOT for 60 min each, including oxygen adaption and separated by a 30 min washout phase.

Results: HFOT was well-tolerated in all patients. A significant decrease in PaCO2 was observed during oxygen adaption of HFOT, and increased PaO2 coincided with significantly increased SpO2 and decreased AaDO2 during both treatment phases. Even at a flow rate of 15 L/min, oxygen requirement delivered as air mixture by HFOT tended to be lower than that of COT (2.2 L/min). Not only was no increase in static or dynamic lung volumes observed during HFOT, but even was a significant reduction of residual lung volume measured in 36 patients (28%).

Conclusions: Thus, short-term use of HFOT is safe in both normocapnic and hypercapnic COPD patients. Lower oxygen levels were effective in correcting hypoxemic respiratory failure and reducing hypercapnia, leading to a reduced amount of oxygen consumption. Long-term studies are needed to assess safety, tolerability, and clinical efficacy of HFOT.

Trial registration: ClinicalTrials.gov NCT01686893 13.09.2012 retrospectively registered (STIT-1) and NCT01693146 14.09.2012 retrospectively registered (STIT-2). Studies were approved by the local ethics committee (Ethikkommission der Medizinischen Universität Innsbruck, Studienkennzahl UN3547, Sitzungsnummer 274/4.19).

Keywords: COPD.; High-flow oxygen; hypercapnic.; normocapnic.; short-term nasal highflow..

Conflict of interest statement

Ethics approval and consent to participate

Studies were registered at All the individuals gave their written informed consent to participate.

Consent for publication

Not applicable.

Competing interests

Helene Vogelsinger received fees for lectures from TNI Medical AG, Würzburg and acts as a consultant for Linde Gas GmbH, Stadl-Paura.

Michael Halank received personal fees for lectures from TNI Medical AG, Würzburg.

Heinrike Wilkens received fees for lectures from TNI Medical AG, Würzburg.

Christian M. Kaehler acts as a consultant for TNI Medical AG, Würzburg.

The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Enrollment of normocapnic and hypercapnic COPD patients in STIT-1 and STIT-2. 200 patients with COPD GOLD IV were screened for study inclusion. The final study population comprised a single cohort of 77 stable COPD patients, who were already treated by conventional long term oxygen treatment (LTOT), then awaiting a potential inclusion into the subsequent HFOT studies STIT-1 and -2 (Short Time TNI Treatment)
Fig. 2
Fig. 2
Study procedures and measurements. Stable patients with COPD GOLD IV (n = 77) successively received conventional oxygen therapy (COT) and nasal high-flow oxygen therapy (HFOT), each for 60 min and separated by a 30 min washout phase. Blood gas and vital signs were analysed at the screening visit, at baseline, after oxygen adaption (PaO2 > 60 mmHg or increased by ≥10 mmHg when compared to baseline), and at the end of each treatment. Bodyplethysmography, spirometry and DLCO measurements were performed at the screening visit, at baseline, and at the end of each 1-h treatment session
Fig. 3
Fig. 3
Mean blood gas values during conventional oxygen therapy (COT) and nasal high-flow oxygen therapy (HFOT). Blood samples (n = 77) were subjected to measurements of PaCO2 (dotted line) and PaO2 (solid line) at baseline (1), after 10–60 min of oxygen adaptation until reaching a value of PaO2 > 60 mmHg or an increase of ≥10 mmHg (2), and at the end of the 60-min treatment period [including adaption] (3)
Fig. 4
Fig. 4
Oxygen requirement during nasal high-flow oxygen therapy (HFOT). Mean oxygen consumption during conventional oxygen therapy (COT) and HFOT was recorded in 77 patients with stable COPD GOLD IV(combining 50 normocapnic and 27 hypercapnic COPD patients), as assessed by blood gas analysis
Fig. 5
Fig. 5
Determination of lung function parameters under nasal high-flow oxygen therapy (HFOT) in 77 stable COPD patients. Dynamic and static lung parameters after both conventional oxygen therapy (COT; white bars) and HFOT (grey bars) were expressed in percent of the predicted value: FEV1 (forced expiratory volume in 1 s), ERV (expiratory reserve volume), IC (inspiratory capacity), VC (vital capacity), RV (residual volume), and TLC (total lung capacity)

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