Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial

Abstract

High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy. Forty‐two COPD patients who had persistent hypercapnia at extubation were assigned randomly to receive HFNC (22) or NIV (20). Twenty patients in each group were enrolled for per‐protocol analysis with regard to primary outcomes. Vital signs and ABGs before extubation were similar between groups. At 3 hr after extubation, pH in the NIV group was lower than HFNC group (7.42 ± 0.06 vs. 7.45 ± 0.05, p = 0.01). At 24 hr after extubation, patients’ mean arterial pressure (82.97 ± 9.04 vs. 92.06 ± 11.11 mmHg, p = 0.05) and pH (7.42 ± 0.05 vs. 7.46 ± 0.03, p = 0.05) in the NIV group were lower than in the HFNC group. No significant differences were found at 48 hr after extubation. In the HFNC group, comfort scores were better (3.55 ± 2.01 vs. 5.15 ± 2.28, p = 0.02) and fewer patients needed bronchoscopy for secretion management within 48 hr after extubation (2/22 vs. 9/20, p = 0.03). HFNC is a potential alternative to NIV to wean hypercapnic COPD patients with regard to vital signs and ABGs, HFNC improved patients’ comfort and secretion clearance.

Year in Review 2019: High-Flow Nasal Cannula Oxygen Therapy for Adult Subjects

“…The authors reported no significant difference in the rate of re-intubation between HFNC and NIV. 6 They also noted that fewer subjects in HFNC group required bronchoscopy for secretion management within 48 h after extubation (2 out of 22 vs 9 out of 20, P ¼ .008). 6 The evidence to support HFNC in this population based on this study is relatively weak due to the small sample size.…”

“…6 They also noted that fewer subjects in HFNC group required bronchoscopy for secretion management within 48 h after extubation (2 out of 22 vs 9 out of 20, P ¼ .008). 6 The evidence to support HFNC in this population based on this study is relatively weak due to the small sample size. Future studies with larger sample sizes are needed to generate more conclusive evidence.…”

“…11 If HFNC was used for longer periods of time, it is plausible that the re-intubation rate at day 7 would have been different. Jing et al 6 published an RCT that enrolled 42 subjects with COPD who had hypercapnia at extubation. The authors reported no significant difference in the rate of re-intubation between HFNC and NIV.…”

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“…Ample evidence from critical care medicine, neonatal intensive care, flight medicine, and diving physiology support this assertion. [1][2][3][4]21,24,26,29,34,37,47,48] CO2 narcosis is a physiologic condition that results from elevated PaCO2 in arterial blood. Common symptoms are lethargy, confusion, headache, blurred vision, impaired hearing, and loss of consciousness.…”