The prognosis of the patients who treated with high-flow nasal cannulae compared to continuous positive airway pressure therapy in severe acute exacerbation of chronic obstructive pulmonary disease

Abstract

The prognosis of the patients who treated with high-flow nasal cannulae compared to continuous positive airway pressure therapy in severe acute exacerbation of chronic obstructive pulmonary disease Myoung kyu Lee, Sang-ha Kim, Suk joong Yong, Kye chul Shin, Jiwon Choi, Yeun seoung Choi, Ye-ryung Jung, Seok jeong Lee, Won-yeon Lee Yonsei University Wonju College of Medicine, Republic of Korea Background/Purpose: Although high-flow nasal cannula (HFNC) oxygen therapy has been used gradually as a method of respiratory support, its evidence is still lacking. Noninvasive positive pressure ventilation (NIPPV) has been used in chronic obstructive pulmonary disease (COPD) patients, especially with severe acute exacerbation of COPD (AECOPD). The purpose of this study is to investigate and compare the prognosis of severe AECOPD patients who were treated with HFNC therapy and NIPPV. Methods: We conducted a prospective randomized controlled trial to compare HFNC therapy with NIPPV for patients (≥40 years old) with severe AECOPD in a tertiary referral hospital. Seventy-two patients with severe AECOPD having mild to moderate respiratory failure were enrolled in this prospective study. We evaluated 30-day mortality and the duration switching from 2 devices to conventional oxygen therapy. Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and mortality rate was 16.6%. Forty-two patients (72.0 ± 9.1) were managed with HFNC oxygen therapy, and 30 patients (73.1 ± 10.4), with NIPPV. Thirty-day mortality was 14.0% and 19.0% (P = .313) in each treatment group, and the duration switching from 2 devices to conventional oxygen therapy was 7.1 ± 6.6 and 6.4 ± 7.8 days (P= .105), respectively. Conclusions: In severe AECOPD patients with mild to moderate respiratory failure, HFNC oxygen therapy compared to NIPPV did not show a statistical difference in 30-day mortality and the duration until the AECOPD gets improved. We expect that HFNC can be used as substitute in severe AECOPD patient requiring NIPPV; however, more prospective and multicenter studies should be required.