High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial
Abstract Background High-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain. Methods This randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in...
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BMC
2022-04-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-03973-7 |
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| author | Jingen Xia Sichao Gu Wei Lei Jihua Zhang Hui Wei Chao Liu Han Zhang Rongli Lu Liqiong Zhang Mingyan Jiang Chao Hu Zhenshun Cheng Chaojie Wei Yusheng Chen Fengfeng Lu Min Chen Hong Bi Hui Liu Cunzi Yan Hong Teng Yang Yang Chen Liang Yanlei Ge Pengguo Hou Jialin Liu Weiwei Gao Yi Zhang Yingying Feng Cheng Tao Xu Huang Pinhua Pan Hong Luo Chunmei Yun Qingyuan Zhan |
| author_facet | Jingen Xia Sichao Gu Wei Lei Jihua Zhang Hui Wei Chao Liu Han Zhang Rongli Lu Liqiong Zhang Mingyan Jiang Chao Hu Zhenshun Cheng Chaojie Wei Yusheng Chen Fengfeng Lu Min Chen Hong Bi Hui Liu Cunzi Yan Hong Teng Yang Yang Chen Liang Yanlei Ge Pengguo Hou Jialin Liu Weiwei Gao Yi Zhang Yingying Feng Cheng Tao Xu Huang Pinhua Pan Hong Luo Chunmei Yun Qingyuan Zhan |
| author_sort | Jingen Xia |
| collection | DOAJ |
| description | Abstract Background High-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain. Methods This randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in China. Patients with acute COPD exacerbation with mild hypercapnia (pH ≥ 7.35 and arterial partial pressure of carbon dioxide > 45 mmHg) were randomly assigned to either HFNC or conventional oxygen therapy. The primary outcome was the proportion of patients who met the criteria for intubation during hospitalization. Secondary outcomes included treatment failure (intolerance and need for non-invasive or invasive ventilation), length of hospital stay, hospital cost, mortality, and readmission at day 90. Results Among 337 randomized patients (median age, 70.0 years; 280 men [83.1%]; median pH 7.399; arterial partial pressure of carbon dioxide 51 mmHg), 330 completed the trial. 4/158 patients on HFNC and 1/172 patient on conventional oxygen therapy met the criteria for intubation (P = 0.198). Patients progressed to NPPV in both groups were comparable (15 [9.5%] in the HFNC group vs. 22 [12.8%] in the conventional oxygen therapy group; P = 0.343). Compared with conventional oxygen therapy, HFNC yielded a significantly longer median length of hospital stay (9.0 [interquartile range, 7.0–13.0] vs. 8.0 [interquartile range, 7.0–11.0] days) and a higher median hospital cost (approximately $2298 [interquartile range, $1613–$3782] vs. $2005 [interquartile range, $1439–$2968]). There were no significant differences in other secondary outcomes between groups. Conclusions In this multi-center randomized controlled study, HFNC compared to conventional oxygen therapy did not reduce need for intubation among acute COPD exacerbation patients with mild hypercapnia. The future studies should focus on patients with acute COPD exacerbation with respiratory acidosis (pH < 7.35). However, because the primary outcome rate was well below expected, the study was underpowered to show a meaningful difference between the two treatment groups. Trial registration: NCT03003559 . Registered on December 28, 2016. |
| first_indexed | 2024-12-12T22:00:33Z |
| format | Article |
| id | doaj.art-fd9ecdcdf76742b986599a4f220165b5 |
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| language | English |
| last_indexed | 2024-12-12T22:00:33Z |
| publishDate | 2022-04-01 |
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| series | Critical Care |
| spelling | doaj.art-fd9ecdcdf76742b986599a4f220165b52022-12-22T00:10:32ZengBMCCritical Care1364-85352022-04-0126111010.1186/s13054-022-03973-7High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trialJingen Xia0Sichao Gu1Wei Lei2Jihua Zhang3Hui Wei4Chao Liu5Han Zhang6Rongli Lu7Liqiong Zhang8Mingyan Jiang9Chao Hu10Zhenshun Cheng11Chaojie Wei12Yusheng Chen13Fengfeng Lu14Min Chen15Hong Bi16Hui Liu17Cunzi Yan18Hong Teng19Yang Yang20Chen Liang21Yanlei Ge22Pengguo Hou23Jialin Liu24Weiwei Gao25Yi Zhang26Yingying Feng27Cheng Tao28Xu Huang29Pinhua Pan30Hong Luo31Chunmei Yun32Qingyuan Zhan33Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow UniversityDepartment of Pulmonary and Critical Care Medicine, The People’s Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Inner Mongolia People’s HospitalDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow UniversityDepartment of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South UniversityDepartment of Pulmonary and Critical Care Medicine, Xiangya Hospital, Central South UniversityDepartment of Pulmonary and Critical Care Medicine, The People’s Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Xiangtan Central HospitalDepartment of Pulmonary and Critical Care Medicine, Xiangtan Central HospitalDepartment of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan UniversityDepartment of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan UniversityDepartment of Pulmonary and Critical Care Medicine, Fujian Provincial HospitalDepartment of Pulmonary and Critical Care Medicine, Fujian Provincial HospitalDepartment of Pulmonary and Critical Care Medicine, Calmette Hospital and The First Hospital of KunmingDepartment of Pulmonary and Critical Care Medicine, Calmette Hospital and The First Hospital of KunmingDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical UniversityDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaDepartment of Pulmonary and Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChinese Alliance for Respiratory Diseases in Primary CareDepartment of Pulmonary and Critical Care Medicine, North China University of Science and Technology Affiliated HospitalDepartment of Pulmonary and Critical Care Medicine, The Third People’s Hospital of DatongDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai JiaoTong University School of MedicineDepartment of Respiratory Medicine, The Second Affiliated Hospital of Zhengzhou UniversityDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalDepartment of Pulmonary and Critical Care Medicine, Xiangya Hospital, Central South UniversityDepartment of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South UniversityDepartment of Pulmonary and Critical Care Medicine, Inner Mongolia People’s HospitalDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship HospitalAbstract Background High-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain. Methods This randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in China. Patients with acute COPD exacerbation with mild hypercapnia (pH ≥ 7.35 and arterial partial pressure of carbon dioxide > 45 mmHg) were randomly assigned to either HFNC or conventional oxygen therapy. The primary outcome was the proportion of patients who met the criteria for intubation during hospitalization. Secondary outcomes included treatment failure (intolerance and need for non-invasive or invasive ventilation), length of hospital stay, hospital cost, mortality, and readmission at day 90. Results Among 337 randomized patients (median age, 70.0 years; 280 men [83.1%]; median pH 7.399; arterial partial pressure of carbon dioxide 51 mmHg), 330 completed the trial. 4/158 patients on HFNC and 1/172 patient on conventional oxygen therapy met the criteria for intubation (P = 0.198). Patients progressed to NPPV in both groups were comparable (15 [9.5%] in the HFNC group vs. 22 [12.8%] in the conventional oxygen therapy group; P = 0.343). Compared with conventional oxygen therapy, HFNC yielded a significantly longer median length of hospital stay (9.0 [interquartile range, 7.0–13.0] vs. 8.0 [interquartile range, 7.0–11.0] days) and a higher median hospital cost (approximately $2298 [interquartile range, $1613–$3782] vs. $2005 [interquartile range, $1439–$2968]). There were no significant differences in other secondary outcomes between groups. Conclusions In this multi-center randomized controlled study, HFNC compared to conventional oxygen therapy did not reduce need for intubation among acute COPD exacerbation patients with mild hypercapnia. The future studies should focus on patients with acute COPD exacerbation with respiratory acidosis (pH < 7.35). However, because the primary outcome rate was well below expected, the study was underpowered to show a meaningful difference between the two treatment groups. Trial registration: NCT03003559 . Registered on December 28, 2016.https://doi.org/10.1186/s13054-022-03973-7High-flow nasal cannulaRespiratory supportRespiratory insufficiencyPulmonary diseaseChronic obstructiveHypercapnia |
| spellingShingle | Jingen Xia Sichao Gu Wei Lei Jihua Zhang Hui Wei Chao Liu Han Zhang Rongli Lu Liqiong Zhang Mingyan Jiang Chao Hu Zhenshun Cheng Chaojie Wei Yusheng Chen Fengfeng Lu Min Chen Hong Bi Hui Liu Cunzi Yan Hong Teng Yang Yang Chen Liang Yanlei Ge Pengguo Hou Jialin Liu Weiwei Gao Yi Zhang Yingying Feng Cheng Tao Xu Huang Pinhua Pan Hong Luo Chunmei Yun Qingyuan Zhan High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial Critical Care High-flow nasal cannula Respiratory support Respiratory insufficiency Pulmonary disease Chronic obstructive Hypercapnia |
| title | High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial |
| title_full | High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial |
| title_fullStr | High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial |
| title_full_unstemmed | High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial |
| title_short | High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial |
| title_sort | high flow nasal cannula versus conventional oxygen therapy in acute copd exacerbation with mild hypercapnia a multicenter randomized controlled trial |
| topic | High-flow nasal cannula Respiratory support Respiratory insufficiency Pulmonary disease Chronic obstructive Hypercapnia |
| url | https://doi.org/10.1186/s13054-022-03973-7 |
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