The use of high-flow nasal cannula in patients with chronic obstructive pulmonary disease under exacerbation and stable phases: A systematic review and meta-analysis

Yang, Huan; Huang, Dong; Luo, Jian; Liang, Zongan; Li, Jie

doi:10.1016/j.hrtlng.2023.02.016

Cited by 11 publications

(2 citation statements)

References 42 publications

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“…Fifteen (75%) of these were men. Regarding clinical characteristics, the subjects had a median body mass index (BMI) of 27.6 (19.4-31.9 kg/m 2 ) and a median APACHE II score of 15 (9)(10)(11)(12)(13)(14)(15)(16)(17) points. Fifteen subjects (60%) were classified as GOLD IV.…”

Section: Patients' Characteristicsmentioning

confidence: 99%

“…Recent meta-analyses in COPD found that HFNC significantly reduces P a CO 2 compared to conventional oxygen therapy (COT) [8][9][10]. On the other hand, conflicting results are observed in patients with AECOPD, one meta-analysis concluded no significant benefit in reducing ETI compared with NIV [11], while another indicated that HFNC is non-inferior to NIV in decreasing the risk of ETI during AECOPD [12].…”

Section: Introductionmentioning

confidence: 99%

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Effect of high-flow nasal cannula at different flow rates on diaphragmatic function in subjects recovering from an acute exacerbation of COPD: a physiological prospective pilot study

Colaianni-Alfonso,

Castro,

Cáceres

et al. 2024

J Anesth Analg Crit Care

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Background Noninvasive ventilation (NIV) is widely employed as the initial treatment for patients with chronic acute exacerbation of obstructive pulmonary disease (AECOPD). Nevertheless, high-flow nasal cannula (HFNC) has been increasingly utilized and investigated to mitigate the issues associated with NIV. Flow rate may play a significant role in diaphragmatic function among subjects recovering from AECOPD. Based on these observations, we conducted a physiological study to assess the impact of HFNC therapy on diaphragmatic function, as measured by US, respiratory rate (RR), gas exchange, and patient comfort at various flow rates. Methods A prospective physiological pilot study enrolled subjects with a diagnosis of AECOPD who required NIV for more than 24 h. After stabilization, these subjects underwent a 30-min trial using NIV and HFNC at different sequential flow rates (30–60 L/min). At the end of each trial, diaphragmatic displacement (DD, cm) and diaphragmatic thickness fraction (DTF, %) were measured using ultrasound. Additionally, other physiological variables, such as RR, gas exchange, and patient comfort, were recorded. Results A total of 20 patients were included in the study. DD was no different among trials (p = 0.753). DTF (%) was significantly lower with HFNC-30 L/min compared to HFNC-50 and 60 L/min (p < 0.001 for all comparisons). No significant differences were found in arterial pH and PaCO2 at discontinuation of NIV and at the end of HFNC trials (p > 0.050). During HFNC trials, RR remained unchanged without statistically significant differences (p = 0.611). However, we observed that HFNC improved comfort compared to NIV (p < 0.001 for all comparisons). Interestingly, HFNC at 30 and 40 L/min showed greater comfort during trials. Conclusions In subjects recovering from AECOPD and receiving HFNC, flows above 40 L/min may not offer additional benefits in terms of comfort and decreased respiratory effort. HFNC could be a suitable alternative to COT during breaks off NIV.

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