High Flow Oxygen Therapy
High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary diseases with acute-moderate hypercapnic respiratory failure: an observational cohort study
Dingyu Tan, Bingyu Ling, Jiayan Sun, Ping Geng, Jun Xu, Huadong Zhu, Xuezhong Yu
Published 2018-04-10
Cite as Chin J Emerg Med, 2018, 27(4): 361-366. DOI: 10.3760/cma.j.issn.1671-0282.2018.04.005
Abstract
ObjectiveTo compare the efficacy of high flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with acute-moderate typeⅡ respiratory failure, and to explore the feasibility of HFNC in the treatment of COPD with respiratory failure.
MethodsPatients diagnosed with COPD with acute moderate typeⅡ respiratory failure (Arterial blood gas pH 7.25-7.35, PaCO2> 50 mmHg) admitted to the ICUs from April 2017 to December 2017 were retrospectively analyzed. All patients who were treated with HFNC within the first 4 hours after the admission to the ICUs, and continued for more than 2 hours and for at least 4 hours within the first 24 hours were included in the HFNC group. Those treated with NIV in the same conditions were included in the NIV group. The end point was the failure rates of treatment (changing to respiratory support method in another group or invasive ventilation) and 28-day mortality.
ResultsEighty-two patients (39 in the HFNC group and 43 in the NIV group) were enrolled. The HFNC group had a treatment failure rate of 28.2%, which was lower than that of the NIV group (39.5%). However, Kaplan-Meier curve analysis showed no significant difference between the two groups (Log Rank test 1.228, P=0.268). The 28-day mortality rate in HFNC group was 15.4%, which was no different from 14% in NIV group (Log Rank test 0.049, P=0.824). The number of airway care interventions within the first 24 hours was significantly lower in the HFNC group than in the NIV group [5 (3~8) vs. 11 (7~15)], whereas the duration of respiratory support within the first 24 hours was significantly longer in the HFNC group than in the NIV group [16 (9~22) hours vs. 8 (4~11) hours] (all P<0.05). The incidence of nasal facial lesions in the NIV group was 20.9%, significantly higher than that of HFNC group (5.1%, P <0.05).
ConclusionFor COPD with acute moderate typeⅡ respiratory failure, HFNC has similar therapeutic effects as NIV. HFNC has better therapeutic tolerance and is a new potential respiratory support method for clinical treatment of COPD with respiratory failure.
Key words:
Chronic obstructive pulmonary diseases; Respiratory failure; High-flow nasal cannula oxygen therapy; Non-invasive ventilation; Cohort study
Contributor Information
Dingyu Tan
Emergency Department, Northern Jiangsu People's Hospital, Yangzhou 225001, China
Bingyu Ling
Emergency Department, Northern Jiangsu People's Hospital, Yangzhou 225001, China
Jiayan Sun
Emergency Department, Northern Jiangsu People's Hospital, Yangzhou 225001, China
Ping Geng
Emergency Department, Northern Jiangsu People's Hospital, Yangzhou 225001, China
Jun Xu
Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing 100730, China
Huadong Zhu
Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing 100730, China
Xuezhong Yu
Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing 100730, China
