Comparison of High-Flow Nasal Cannula with Conventional Oxygen Therapy in Patients with Hypercapnic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Int J Chron Obstruct Pulmon Dis. 2023 May 16:18:895-906. doi: 10.2147/COPD.S402506. eCollection 2023.

Abstract

Purpose: This study aimed to evaluate the clinical outcomes of high-flow nasal cannula (HFNC) compared with conventional oxygen therapy (COT) in patients with hypercapnic chronic obstructive pulmonary disease (COPD), including arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), respiratory rate (RR), treatment failure, exacerbation rates, adverse events and comfort evaluation.

Patients and methods: PubMed, EMBASE and the Cochrane Library were retrieved from inception to September 30, 2022. Eligible trials were randomized controlled trials and crossover studies comparing HFNC and COT in hypercapnic COPD patients. Continuous variables were reported as mean and standard derivation and calculated by weighted mean differences (MD), while dichotomous variables were shown as frequency and proportion and calculated by odds ratio (OR), with the 95% confidence intervals (Cl). Statistical analysis was performed using RevMan 5.4 software.

Results: Eight studies were included, five with acute hypercapnia and three with chronic hypercapnia. In acute hypercapnic COPD, short-term HFNC reduced PaCO2 (MD -1.55, 95% CI: -2.85 to -0.25, I² = 0%, p <0.05) and treatment failure (OR 0.54, 95% CI: 0.33 to 0.88, I² = 0%, p<0.05), but there were no significant differences in PaO2 (MD -0.36, 95% CI: -2.23 to 1.52, I² = 45%, p=0.71) and RR (MD -1.07, 95% CI: -2.44 to 0.29, I² = 72%, p=0.12). In chronic hypercapnic COPD, HFNC may reduce COPD exacerbation rates, but there was no advantage in improving PaCO2 (MD -1.21, 95% CI: -3.81 to 1.39, I² = 0%, p=0.36) and PaO2 (MD 2.81, 95% CI: -1.39 to 7.02, I² = 0%, p=0.19).

Conclusion: Compared with COT, short-term HFNC reduced PaCO2 and the need for escalating respiratory support in acute hypercapnic COPD, whereas long-term HFNC reduced COPD exacerbations rates in chronic hypercapnia. HFNC has great potential for treating hypercapnic COPD.

Keywords: chronic obstructive pulmonary disease; conventional oxygen therapy; hypercapnia; meta-analysis; nasal high-flow oxygen therapy.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Cannula
  • Humans
  • Hypercapnia / diagnosis
  • Hypercapnia / etiology
  • Hypercapnia / therapy
  • Noninvasive Ventilation* / adverse effects
  • Oxygen
  • Oxygen Inhalation Therapy / adverse effects
  • Pulmonary Disease, Chronic Obstructive* / complications
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Randomized Controlled Trials as Topic
  • Respiratory Insufficiency*

Substances

  • Oxygen

Grants and funding

This study was supported by the National Natural Science Foundation of China [Grant numbers 81870033]; the Six Talent Peaks Project of Jiangsu Province [Grant number WSN-106]; the Medical Scientific Research Foundation of Jiangsu Province of China [Grant numbers QNRC2016340]; and the Foundation for High-level Talents during the 13th Five-year Plan Period of Yangzhou, China [Grant numbers ZDRC201866].