High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease with Acute Compensated Hypercapnic Respiratory Failure: A Randomized, Controlled Trial

Int J Chron Obstruct Pulmon Dis. 2020 Nov 24:15:3051-3061. doi: 10.2147/COPD.S283020. eCollection 2020.

Abstract

Introduction: Currently, there is a lack of evidence on the utilization of high-flow nasal cannula (HFNC) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied by hypercapnic respiratory failure. We aimed to explore the efficacy and safety of HFNC compared with conventional oxygen therapy (COT) in such patients.

Methods: This was a prospective, randomized, controlled trial. Patients with AECOPD with a baseline arterial blood gas pH ≥7.35, PaO2 <60 mmHg, and PaCO2 >45 mmHg were enrolled. The primary endpoint was treatment failure, which needs mechanical ventilation.

Results: A total of 320 patients were randomized to either the HFNC group (n = 160) or the COT group (n = 160). Sixteen (10.0%) patients in the HFNC group had treatment failure during hospitalization, which was significantly lower than the COT group figure of 31 (19.4%) patients (p = 0.026). Twenty-four hours after recruitment, the PaCO2 of the HFNC group was lower than that of the COT group (54.1 ± 9.79 mmHg vs 56.9 ± 10.1 mmHg, p = 0.030). PaCO2 higher than 59 mmHg after HFNC for 24 h was identified as an independent risk factor for treatment failure [OR 1.078, 95% CI 1.006-1.154, p = 0.032].

Conclusion: In AECOPD patients with acute compensated hypercapnic respiratory failure, HFNC improved the prognosis compared with COT. Therefore, HFNC might be considered for first-line oxygen therapy in select patients.

Trial registration number: ClinicalTrials.Gov: NCT02439333.

Keywords: chronic obstructive pulmonary disease; conventional oxygen therapy; exacerbation; high-flow nasal cannula; hypercapnic respiratory failure.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cannula
  • Humans
  • Noninvasive Ventilation* / adverse effects
  • Oxygen Inhalation Therapy
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive* / complications
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Respiratory Insufficiency* / diagnosis
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / therapy

Associated data

  • ClinicalTrials.gov/NCT02439333

Grants and funding

This work was supported by the Capital Health Research and Development of Specialties program of the Beijing Municipal Commission of Health and Family Planning (No. shoufa 2016-1-1061), the National Science and Technology Supporting Plan of the Ministry of Science and Technology of China (No. 2012BAI11B05), Xinjiang Science and Technology Projects (NO. 201591156), and the Program of Science and Technology of the Beijing Municipal (No. Z151100004015049).