Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report

Abstract

IntroductionSleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO2 levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system.Case presentationWe report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO2 narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO2 had increased from 89 to 93%, percentage time with SpO2 ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO2 narcosis and has been able to continue home treatment.ConclusionsUse of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure.

Evaluation by various methods of the physiological mechanism of a high-flow nasal cannula (HFNC) in healthy volunteers

“…We earlier reported that HFNC use improved CO 2 narcosis in acute COPD exacerbations and improved sleep alveolar hypoventilation with PSG. 24 Bräunlich et al reported night-time use of an HFNC for 6 weeks in patients with stable hypercapnic COPD, but there was no significant difference from NPPV. Based on the present study, as well, it may be possible to prevent the onset of pulmonary hypertension and improve the prognosis of patients with chronic phase COPD by using HFNCs, which show high tolerability.…”

Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover trial

“…This reduction in TcCO 2 correlates with the consistent rise in Vt, and we believe this increase may be accompanied by dead space and subsequent CO 2 washout, as seen in preceding COPD studies. 6 …”

“… 4 The observed clinical effects of high gas flows in patients with COPD include improvements in exercise tolerance, oxygenation and reduced dyspnoea. 5 6 NHF has been demonstrated to increase tidal volumes in a number of cohorts, 7 while reducing work of breathing by lowering inspiratory resistance and generating positive expiratory pressure. 5 NHF has been shown to be non-inferior to non-invasive ventilation in the prevention of treatment failure in patients with acute respiratory failure postcardiac surgery 8 and reduce mortality (both in the intensive care unit and at 90 days) in patients with acute respiratory failure.…”

Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure

“…Two short studies and one case-report have described the effects of HFNC therapy on nocturnal hypoventilation. Okuda et al [ 73 ] reported a patient on HFNC therapy in whom the Apnea–Hypopnea Index decreased while oxygenation improved. HFNC therapy was continued at home without any recurrences of CO 2 narcosis.…”