<p>High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: an observational cohort study</p>

Abstract

Background High-flow nasal cannula (HFNC) oxygen therapy in acute hypoxic respiratory failure is becoming increasingly popular. However, evidence to support the use of HFNC in acute respiratory failure (ARF) with hypercapnia is limited. Methods Chronic obstructive pulmonary disease (COPD) patients with moderate hypercapnic ARF (arterial blood gas pH 7.25–7.35, PaCO 2 >50 mmHg) who received HFNC or non-invasive ventilation (NIV) in the intensive care uint from April 2016 to March 2018 were analyzed retrospectively. The endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa), and 28-day mortality. Results Eighty-two COPD patients (39 in the HFNC group and 43 in the NIV group) were enrolled in this study. The mean age was 71.8±8.2 and 54 patients (65.9%) were male. The treatment failed in 11 out of 39 patients with HFNC (28.2%) and in 17 of 43 patients with NIV (39.5%) ( P =0.268). No significant differences were found for 28-day mortality (15.4% in the HFNC group and 14% in the NIV group, P =0.824). During the first 24 hrs of treatment, the number of nursing airway care interventions in the HFNC group was significantly less than in the NIV group, while the duration of device application was significantly longer in the HFNC group (all P <0.05). Skin breakdown was significantly more common in the NIV group (20.9% vs 5.1%, P <0.05). Conclusion Among COPD patients with moderate hypercarbic ARF, the use of HFNC compared with NIV did not result in increased rates of treatment failure, while there were fewer nursing interventions and skin breakdown episodes reported in the HFNC group.

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

“…In that study, the authors reported a similar incidence of treatment failure between the 2 groups. 48 They also reported fewer incidences of skin breakdown and nursing interventions in HFNC group (Table 5). 48 In a crossover physiological study, Longhini et al 49 enrolled 30 subjects with COPD exacerbation who had used NIV for > 24 h. Five 30-min trials were designed; HFNC and O 2 therapy were randomly assigned in the second and fourth trials, and NIV was utilized in the other 3 trials.…”

“…48 They also reported fewer incidences of skin breakdown and nursing interventions in HFNC group (Table 5). 48 In a crossover physiological study, Longhini et al 49 enrolled 30 subjects with COPD exacerbation who had used NIV for > 24 h. Five 30-min trials were designed; HFNC and O 2 therapy were randomly assigned in the second and fourth trials, and NIV was utilized in the other 3 trials. Diaphragm thickening fraction increased significantly during the O 2 therapy 49 This promising finding may support HFNC as alternative to NIV in mild to moderate COPD patients, although more high-quality studies are warranted before making conclusion.…”

Factors Associated With Failure of High-Flow Nasal Cannula

“…In the postextubation subjects without DNR/DNI, the HFNC failure rate was 27.1%, which was higher than the result from a prospective study with low-risk subjects (4.9%) 40 and was comparable with high-risk subjects (22.8%). 41 Despite the fact that HFNC is not a ventilator and may be limited regarding the ability to eliminate CO 2 , HFNC has been attempted as an alternative to NIV in hypercapnia [42][43][44] because NIV is uncomfortable and interferes with speaking and eating. In non-DNR/DNI subjects with acute hypercapnic respiratory failure, the HFNC failure rate was higher than in all non-DNR/DNI subjects (35.6% vs 27.1%), indicating cautious HFNC use in hypercapnia.…”

Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

“…The authors reported similar failure and mortality rates in patients treated with both therapies, with fewer nursing interventions and skin breakdown episodes reported in the HFNT group. 92 In 88 patients with severe COPD Table 4 Potential physiological benefits of high-flow nasal therapy compared with conventional oxygen therapy 70…”