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

Authors Li XY, Tang X, Wang R, Yuan X, Zhao Y, Wang L, Li HC, Chu HW, Li J, Mao WP, Wang YJ, Tian ZH, Liu JH, Luo Q, Sun B, Tong ZH

Received 24 September 2020

Accepted for publication 16 November 2020

Published 24 November 2020 Volume 2020:15 Pages 3051—3061


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Richard Russell

Xu-Yan Li,1– 4,* Xiao Tang,1– 4,* Rui Wang,1– 4 Xue Yuan,1– 4 Yu Zhao,1– 4 Li Wang,1– 4 Hai-Chao Li,1– 4 Hui-Wen Chu,1– 4 Jie Li,5 Wen-Ping Mao,5 Yu-Jun Wang,6 Zhan-Hong Tian,6 Jian-Hua Liu,6 Qin Luo,7 Bing Sun,1– 4 Zhao-Hui Tong1– 4

1Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Institute of Respiratory Medicine, Beijing, People’s Republic of China; 3Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People’s Republic of China; 4Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital-West Branch, Beijing, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Beijing Huai-Rou Hospital of University of Chinese Academy of Science, Beijing, People’s Republic of China; 7Department of Respiratory Neurology, Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Bing Sun
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongrentiyuguannan Road, Chaoyang, Beijing 100020, People’s Republic of China
Tel +86 1085231543

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, exacerbation, high-flow nasal cannula, conventional oxygen therapy, hypercapnic respiratory failure

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