Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Jul 18;28(1):250.
doi: 10.1186/s13054-024-05040-9.

High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial

Dingyu Tan #  1 , Bingxia Wang #  1 , Peng Cao  1 , Yunyun Wang  2 , Jiayan Sun  3 , Ping Geng  1 , Joseph Harold Walline  4 , Yachao Wang  1 , Chenlong Wang  1
Affiliations
Randomized Controlled Trial

High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial

Dingyu Tan et al. Crit Care. .

Abstract

Background: Although cumulative studies have demonstrated a beneficial effect of high-flow nasal cannula oxygen (HFNC) in acute hypercapnic respiratory failure, randomized trials to compare HFNC with non-invasive ventilation (NIV) as initial treatment in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with acute-moderate hypercapnic respiratory failure are limited. The aim of this randomized, open label, non-inferiority trial was to compare treatment failure rates between HFNC and NIV in such patients.

Methods: Patients diagnosed with AECOPD with a baseline arterial blood gas pH between 7.25 and 7.35 and PaCO2 ≥ 50 mmHg admitted to two intensive care units (ICUs) at a large tertiary academic teaching hospital between March 2018 and December 2022 were randomly assigned to HFNC or NIV. The primary endpoint was the rate of treatment failure, defined as endotracheal intubation or a switch to the other study treatment modality. Secondary endpoints were rates of intubation or treatment change, blood gas values, vital signs at one, 12, and 48 h, 28-day mortality, as well as ICU and hospital lengths of stay.

Results: 225 total patients (113 in the HFNC group and 112 in the NIV group) were included in the intention-to-treat analysis. The failure rate of the HFNC group was 25.7%, while the NIV group was 14.3%. The failure rate risk difference between the two groups was 11.38% (95% CI 0.25-21.20, P = 0.033), which was higher than the non-inferiority cut-off of 9%. In the per-protocol analysis, treatment failure occurred in 28 of 110 patients (25.5%) in the HFNC group and 15 of 109 patients (13.8%) in the NIV group (risk difference, 11.69%; 95% CI 0.48-22.60). The intubation rate in the HFNC group was higher than in the NIV group (14.2% vs 5.4%, P = 0.026). The treatment switch rate, ICU and hospital length of stay or 28-day mortality in the HFNC group were not statistically different from the NIV group (all P > 0.05).

Conclusion: HFNC was not shown to be non-inferior to NIV and resulted in a higher incidence of treatment failure than NIV when used as the initial respiratory support for AECOPD patients with acute-moderate hypercapnic respiratory failure.

Trial registration: chictr.org (ChiCTR1800014553). Registered 21 January 2018, http://www.chictr.org.cn.

Keywords: Chronic obstructive pulmonary diseases; High-flow nasal cannula oxygen therapy; Non-invasive ventilation; Randomized controlled trial; Respiratory failure.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrollment. COPD: Chronic obstructive pulmonary disease; ICU: Intensive care unit; HFNC: High-flow nasal cannula oxygen therapy; NIV: Non-invasive ventilation
Fig. 2
Fig. 2
Kaplan–Meier curve analysis for cumulative failure rate. HFNC: High-flow nasal cannula oxygen therapy; NIV: Non-invasive ventilation
Fig. 3
Fig. 3
Kaplan–Meier curve analysis for cumulative survival rate. HFNC: High-flow nasal cannula oxygen therapy; NIV: Non-invasive ventilation
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7(7):CD004104. - PMC - PubMed
    1. Cortegiani A, Russotto V, Antonelli M, Azoulay E, Carlucci A, Conti G, et al. Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: a report of expert opinions. BMC Anesthesiol. 2017;17(1):122. - PMC - PubMed
    1. Bruni A, Garofalo E, Pelaia C, Messina A, Cammarota G, Murabito P, et al. Patient-ventilator asynchrony in adult critically ill patients. Minerva Anestesiol Italy. 2019;85(6):676–88. - PubMed
    1. Nagata K, Horie T, Chohnabayashi N, Jinta T, Tsugitomi R, Shiraki A, et al. Home high-flow nasal cannula oxygen therapy for stable hypercapnic COPD: a randomized clinical trial. Am J Respir Crit Care Med. 2022;206(11):1326–35. - PMC - PubMed
    1. Spoletini G, Cortegiani A, Gregoretti C. Physiopathological rationale of using high-flow nasal therapy in the acute and chronic setting: a narra tive review. Trends Anaesth Crit Care. 2019;26–27:22–9.

Publication types

MeSH terms

LinkOut - more resources