Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study
Abstract Background Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in Pa...
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| Format: | Article |
| Language: | English |
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BMC
2020-01-01
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| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12890-020-1048-7 |
| _version_ | 1828947937101611008 |
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| author | Lara Pisani Sara Betti Carlotta Biglia Luca Fasano Vito Catalanotti Irene Prediletto Vittoria Comellini Letizia Bacchi-Reggiani Stefano Nava FERS |
| author_facet | Lara Pisani Sara Betti Carlotta Biglia Luca Fasano Vito Catalanotti Irene Prediletto Vittoria Comellini Letizia Bacchi-Reggiani Stefano Nava FERS |
| author_sort | Lara Pisani |
| collection | DOAJ |
| description | Abstract Background Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed the acceptability of HFNC and its effectiveness in reducing the level of PaCO2 in patients recovering from an Acute Hypercapnic Respiratory Failure (AHRF) episode. We also hypothesized that the response in CO2 clearance is dependent on baseline level of hypercapnia. Methods Fifty COPD patients recovering from an acute exacerbation and with persistent hypercapnia, despite having attained a stable pH (i.e. pH > 7,35 and PaCO2 > 45 mmHg on 3 consecutive measurements), were enrolled and treated with HFNC for at least 8 h/day and during the nighttime Results HFNC was well tolerated with a global tolerance score of 4.0 ± 0.9. When patients were separated into groups with or without COPD/OSA overlap syndrome, the “pure” COPD patients showed a statistically significant response in terms of PaCO2 decrease (p = 0.044). In addition, the subset of patients with a lower pH at enrolment were those who responded best in terms of CO2 clearance (score test for trend of odds, p = 0.0038). Conclusions HFNC is able to significantly decrease the level of PaCO2 after 72 h only in “pure” COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV. Trial registration This study is registered with www. clinicaltrials.gov with identifier number NCT03759457. |
| first_indexed | 2024-12-14T05:37:26Z |
| format | Article |
| id | doaj.art-588ae66343f247409ebf272e374f9d2c |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-14T05:37:26Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-588ae66343f247409ebf272e374f9d2c2022-12-21T23:15:07ZengBMCBMC Pulmonary Medicine1471-24662020-01-012011910.1186/s12890-020-1048-7Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot studyLara Pisani0Sara Betti1Carlotta Biglia2Luca Fasano3Vito Catalanotti4Irene Prediletto5Vittoria Comellini6Letizia Bacchi-Reggiani7Stefano Nava FERS8Respiratory and Critical Care Unit, University Hospital St. Orsola-MalpighiRespiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-MalpighiRespiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-MalpighiRespiratory and Critical Care Unit, University Hospital St. Orsola-MalpighiRespiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-MalpighiRespiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-MalpighiRespiratory and Critical Care Unit, University Hospital St. Orsola-MalpighiDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of BolognaRespiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-MalpighiAbstract Background Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed the acceptability of HFNC and its effectiveness in reducing the level of PaCO2 in patients recovering from an Acute Hypercapnic Respiratory Failure (AHRF) episode. We also hypothesized that the response in CO2 clearance is dependent on baseline level of hypercapnia. Methods Fifty COPD patients recovering from an acute exacerbation and with persistent hypercapnia, despite having attained a stable pH (i.e. pH > 7,35 and PaCO2 > 45 mmHg on 3 consecutive measurements), were enrolled and treated with HFNC for at least 8 h/day and during the nighttime Results HFNC was well tolerated with a global tolerance score of 4.0 ± 0.9. When patients were separated into groups with or without COPD/OSA overlap syndrome, the “pure” COPD patients showed a statistically significant response in terms of PaCO2 decrease (p = 0.044). In addition, the subset of patients with a lower pH at enrolment were those who responded best in terms of CO2 clearance (score test for trend of odds, p = 0.0038). Conclusions HFNC is able to significantly decrease the level of PaCO2 after 72 h only in “pure” COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV. Trial registration This study is registered with www. clinicaltrials.gov with identifier number NCT03759457.https://doi.org/10.1186/s12890-020-1048-7Chronic obstructive pulmonary diseaseHigh flow nasal cannulaPersistent hypercapniaLong term non invasive ventilation |
| spellingShingle | Lara Pisani Sara Betti Carlotta Biglia Luca Fasano Vito Catalanotti Irene Prediletto Vittoria Comellini Letizia Bacchi-Reggiani Stefano Nava FERS Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study BMC Pulmonary Medicine Chronic obstructive pulmonary disease High flow nasal cannula Persistent hypercapnia Long term non invasive ventilation |
| title | Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study |
| title_full | Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study |
| title_fullStr | Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study |
| title_full_unstemmed | Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study |
| title_short | Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study |
| title_sort | effects of high flow nasal cannula in patients with persistent hypercapnia after an acute copd exacerbation a prospective pilot study |
| topic | Chronic obstructive pulmonary disease High flow nasal cannula Persistent hypercapnia Long term non invasive ventilation |
| url | https://doi.org/10.1186/s12890-020-1048-7 |
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