High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study

Abstract

Background The use of High-flow nasal cannula (HFNC) is increasing in admitted COPD-patients and could provide a step in between non-invasive ventilation (NIV) and standard oxygen supply. Recent studies demonstrated that HFNC is capable of facilitating secretion removal and reduce the work of breathing. Therefore, it might be of advantage in the treatment of acute exacerbations of COPD (AECOPD). No randomized trials have assessed this for admitted COPD-patients on a regular ward and only limited data from non-randomized studies is available. Objectives The aim of our study was to identify the reasons to initiate treatment with HFNC in a group of COPD-patients during an exacerbation, further identify those most likely to benefit from HFNC treatment and to find factors associated with treatment success on the pulmonary ward. Material and methods This retrospective study included COPD-patients admitted to the pulmonary ward and treated with HFNC from April 2016 until April 2019. Only patients admitted with severe acute exacerbations were included. Patients who had an indication for NIV-treatment where treated with NIV and were included only if they subsequently needed HFNC, e.g. when they did not tolerate NIV. Known asthma patients were excluded. Results A total of 173 patients were included. Stasis of sputum was the indication most reported to initiate HFNC-treatment. Treatment was well tolerated in 83% of the patients. Cardiac and vascular co-morbidities were significantly associated with a smaller chance of successful treatment (Respectively OR = 0.435; p = 0.013 and OR = 0.493;p = 0.035). Clinical assessment judged HFNC-treatment to be successful in 61% of the patients. Furthermore, in-hospital treatment with NIV was associated with a higher chance of HFNC failure afterwards (OR = 0.439; p = 0.045). Conclusion This large retrospective study showed that HFNC-treatment in patients with an AECOPD was initiated most often for sputum stasis as primary reason. Factors associated with improved outcomes of HFNC-treatment was the absence of vascular and/or cardiac co-morbidities and no need for in-hospital NIV-treatment.

High-Flow Nasal Cannula versus Noninvasive Ventilation in AECOPD Patients with Respiratory Acidosis: A Retrospective Propensity Score-Matched Study

“…In addition, 32% of patients in HFNC group switched to NIV by 6 hours, and 57.5% received NIV during hospitalization [ 17 ]. In a more recent large retrospective study of 173 hospitalized COPD patients receiving HFNC, 68 patients (39%) experienced HFNC failure [ 29 ].…”

“…Previous studies have shown that elevated NT-proBNP level is associated with worse in-hospital outcomes and is a reliable predictive biomarker of poor prognosis in patients with AECOPD [ 36 , 37 ]. In a more recent study, Veenstra and colleagues found a significant association between cardiac (myocardial infarction, heart failure, or arrhythmia) (OR = 0.435, p = 0.013) and vascular (hypertension and peripheral arterial disease) (OR = 0.493, p = 0.035) comorbidity and a lower likelihood of HFNC success in AECOPD patients [ 29 ]. In the present study, our results further indicate that the NT-proBNP level upon admission might be an important factor for HFNC failure in AECOPD patients with respiratory acidosis.…”

Management of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations in Hospitalized Patients From Admission to Discharge: A Comprehensive Review of Therapeutic Interventions

“…But a few points worth mentioning would be that high-flow methods were non-inferior to NIV in decreasing PaCO 2 within two hours of treatment [ 96 ], and the use of high-flow methods in AECOPD with sputum stasis showed good tolerance among these patients [ 97 ].…”

“…The flow rates for the devices used for oxygen delivery are mentioned in Based on the data in Table 8, we can see that NIV and high-flow oxygen delivery methods do not show significant differences in the outcome of treating AECOPD patients, especially the criteria for intubation. But a few points worth mentioning would be that high-flow methods were non-inferior to NIV in decreasing PaCO 2 within two hours of treatment [96], and the use of high-flow methods in AECOPD with sputum stasis showed good tolerance among these patients [97].…”

Caring for patients with advanced COPD: beyond the inhalers…

“…F rat et al [ 33 ] showed that high flow nasal oxygen (HFNO) was non-inferior to standard oxygen therapy or NIV in preventing intubation with non-hypercapnic acute hypoxic respiratory failure. The use of HFNO is increasing in admitted COPD patients with acute exacerbations and could help with secretion removal and reduce the work of breathing especially in patients who do not require NIV management as part of their treatment, but have severe hypoxaemic respiratory failure [ 34 ]. There are a number of proposed benefits for this specific subgroup of patients, who have a significant degree of mucus burden but do not have severe acidotic respiratory failure.…”