Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD
Received 20 February 2019
Accepted for publication 17 May 2019
Published 5 July 2019 Volume 2019:14 Pages 1411—1421
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Jens Bräunlich,1 Dominic Dellweg,2 Andreas Bastian,3 Stephan Budweiser,4 Winfried Randerath,5 Dora Triché,6 Martin Bachmann,7 Christian Kähler,8 Abdel Hakim Bayarassou,9 Irmhild Mäder,10 Jens Geiseler,11 Norbert Köhler,12 David Petroff,12 Hubert Wirtz1
1Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany; 2Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg Grafschaft, Germany; 3Pneumologie/Intensivmedizin/Infektiologie, Marienkrankenhaus Kassel, Kassel, Germany; 4Medizinische Klinik III, RoMed Klinikum Rosenheim, Rosenheim, Germany; 5Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany; 6Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nürnberg, Germany; 7Intensivmedizin und Beatmungsmedizin, Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Asklepios Klinikum Harburg, Hamburg, Germany; 8Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria; 9Klinik für Pneumologie, Kardiologie, Schlaf- und Beatmungsmedizin, Malteser Krankenhaus Seliger Gerhard, Bonn/Rhein-Sieg, Bonn, Germany; 10Zentralklinik Bad Berka GmbH, Klinik für Pneumologie, Bad Berka, Germany; 11Medizinische Klinik IV, Klinikum Vest - Paracelsus-Klinik Marl, Marl, Germany; 12Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
Background: Despite the encouraging results of noninvasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and nasal high-flow (NHF) to compare effectiveness.
Methods: In a multi-centered, randomized, controlled, cross-over design, patients received 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO2≥50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO2 changes from baseline blood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device use were secondary endpoints.
Results: A total of 102 patients (mean±SD) age 65.3±9.3 years, 61% females, body mass index 23.1±4.8 kg/m,2 90% GOLD D, pCO2 56.5±5.4 mmHg were randomized. PCO2 levels decreased by 4.7% (n=94; full analysis set; 95% CI 1.8–7.5, P=0.002) using NHF and 7.1% (95% CI 4.1–10.1, P<0.001) from baseline using NIV (indistinguishable to intention-to-treat analysis). The difference of pCO2 changes between the two devices was −1.4 mmHg (95% CI −3.1–0.4, P=0.12). Both devices had positive impact on blood gases and respiratory scores (St. George’s Respiratory Questionnaire, Severe Respiratory Insufficiency Questionnaire).
Conclusions: NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, eg, those not tolerating or rejecting NIV with respect to pCO2 reduction and improvement in QoL.
Keywords: noninvasive ventilation, nasal high-flow, COPD, hypercapnia
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