High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation. Research Methods This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay. Results Eight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (−0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different. Conclusion According to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV.

Efficacy of treatment with N‐acetylcysteine inhalation for AECOPD: A propensity‐score‐matched cohort study

“…25 So, some researchers begin to explore the probability of high-flow nasal cannula substituting the non-invasive ventilation in such patients. 26 Our result showed that about 40% of patients suffered from type II respiratory failure, and there was no statistical significance in the incidence of type II respiratory failure between the NAC and Non-NAC groups. Notably, NAC inhalation was related to the lower rate of machine ventilation.…”

“…Mechanical ventilation can be successfully used for patients with acute hypercapnic breathing failure caused by AECOPD but accompanied by high costs and long hospital stays 25 . So, some researchers begin to explore the probability of high‐flow nasal cannula substituting the non‐invasive ventilation in such patients 26 . Our result showed that about 40% of patients suffered from type II respiratory failure, and there was no statistical significance in the incidence of type II respiratory failure between the NAC and Non‐NAC groups.…”

Chronic obstructive pulmonary disease and respiratory failure

“…For COPD patients with type II respiratory failure and a pH between 7.25 and 7.35, HFNC was statistically non-inferior to NIV as initial ventilatory support in decreasing PaCO 2 after 2 hours of treatment in patients with mild-to-moderate AECOPD (Table 1). 30 Table 1. Potential advantages of high-flow nasal cannula in acute exacerbations chronic obstructive pulmonary disease patients.…”

The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review

“…HFNC has been shown to effectively reduce intubation rates for patients with acute hypoxemic respiratory failure (AHRF) [2] and prevent post-extubation respiratory failure [3]. It may also be non-inferior to noninvasive ventilation to prevent reintubation for patients with chronic obstructive pulmonary disease (COPD) [4,5]. Improved patient outcomes associated with HFNC are due to its physiological effects, such as improvement in oxygenation [6][7][8][9][10][11], efficiency of ventilation [6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24], reduction of work of breathing (WOB) [7,11,12,24], avoidance of patient self-inflicted lung injury, and improvement in patient comfort and tolerance [25].…”