Physiological effects of titrated oxygen via nasal high‐flow cannulae in <scp>COPD</scp> exacerbations: <scp>A</scp> randomized controlled cross‐over trial

Pilcher, Janine; Eastlake, Leonie; Richards, Michael; Power, Sharon; Cripps, Terrianne; Bibby, Susan; Braithwaite, Irene; Weatherall, Mark; Beasley, Richard

doi:10.1111/resp.13050

Cited by 86 publications

(129 citation statements)

References 31 publications

(81 reference statements)

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“…A randomized cross‐over study (long‐term oxygen therapy versus HFOT at 30 L/min with room air) confirmed that HFOT reduced CO 2 rebreathing, and also showed that it increased tidal volume and improved breathing pattern with a reduction of respiratory rate without any change in minute ventilation . Similar results have been reported, even in patients with acute exacerbation of COPD …”

Section: Niv As First‐line Treatment For Acute Respiratory Acidosis Dsupporting

confidence: 69%

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

2018

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It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a firstline strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO 2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in postoperative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.

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Section: Niv As First‐line Treatment For Acute Respiratory Acidosis Dsupporting

confidence: 69%

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

2018

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“…In this issue of Respirology , Pilcher et al . published a study of NHF use in patients with an acute exacerbation of COPD (AECOPD).…”

Section: Results Of Different Studies Documented Decrease In Hypercapmentioning

confidence: 99%

“…6,7 In addition, preliminary data are available that demonstrate a potential effectiveness in decreasing hypercapnia. [6][7][8][9][10][11] In this issue of Respirology, Pilcher et al 12 published a study of NHF use in patients with an acute exacerbation of COPD (AECOPD). The investigators prospectively evaluated the influence of titrated oxygen via NHF in a single-centre randomized crossover trial versus low flow oxygen from standard nasal prongs (SNPs).…”

mentioning

confidence: 99%

NHF and hypercapnia: How brief can you look?

Bräunlich¹,

Wirtz²

2017

Respirology

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“…Pilcher et al . found that O 2 delivered via high‐flow nasal cannulae in acute COPD exacerbations reduced CO 2 slightly at 30 min.…”

Section: Copdmentioning

confidence: 99%

“…Pilcher et al 34 found that O 2 delivered via high-flow nasal cannulae in acute COPD exacerbations reduced CO 2 slightly at 30 min. High-flow nasal oxygen is an emergent and potentially important treatment modality in COPD which deserves further research.…”

Section: Non-pharmacological Managementmentioning

confidence: 99%

Year in review 2017: Chronic obstructive pulmonary disease and asthma

Benton

Lim

et al. 2018

Respirology

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Physiological effects of titrated oxygen via nasal high‐flow cannulae in COPD exacerbations: A randomized controlled cross‐over trial

Abstract: Short-term use of NHF results in a small reduction in PtCO compared with SNP in patients with acute exacerbations of COPD, but whether this is clinically significant is uncertain.

Cited by 86 publications

References 31 publications

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

NHF and hypercapnia: How brief can you look?

Year in review 2017: Chronic obstructive pulmonary disease and asthma

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