Current Practice of High Flow through Nasal Cannula in Exacerbated COPD Patients.

Andrea Bruni,Daniela Procopio,Eugenio Biamonte,Federico Longhini,Antonio Caroleo,Corrado Pelaia,Eugenio Garofalo,Silvia Corrado

doi:10.3390/healthcare10030536

Andrea Bruni, Daniela Procopio + Show 6 more

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https://doi.org/10.3390/healthcare10030536

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Abstract

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis.

Highlights

Academic Editor: Luca NicolaChronic Obstructive Pulmonary Disease (COPD) is a common disease characterized by persistent respiratory symptoms and airflow limitation [1]
While only conventional oxygen therapy (COT) may be required in case of sole hypoxemia, respiratory acidosis and carbon dioxide (CO2 ) retention may ensue in 20% of patients because of an excessive respiratory workload over the respiratory muscles pump capacity [2]
non-invasive ventilation (NIV) is recommended for all those patients with acute respiratory failure (ARF) leading to acute or acute-on-chronic respiratory acidosis, whereas there is no indication if patients encounter an acute exacerbation of COPD (AECOPD) and hypercapnia without acidosis [2]

Summary

Introduction

Academic Editor: Luca NicolaChronic Obstructive Pulmonary Disease (COPD) is a common disease characterized by persistent respiratory symptoms and airflow limitation [1]. In case of severe exacerbation, COPD patients may develop an acute respiratory failure (ARF) of varying entities, sometimes requiring hospital admission due to the deterioration of the gas exchange. While only conventional oxygen therapy (COT) may be required in case of sole hypoxemia, respiratory acidosis and carbon dioxide (CO2 ) retention may ensue in 20% of patients because of an excessive respiratory workload over the respiratory muscles pump capacity [2]. In these latter cases, non-invasive ventilation (NIV) plays a major role. Up to 64% of AECOPD patients may fail NIV mainly due to worsened respiratory function, intolerance of the interface, cardiovascular instability and neurological deterioration [3]

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