Nasal High Flow Use in COPD Patients with Hypercapnic Respiratory Failure: Treatment Algorithm & Review of the Literature

Background: Some patients with idiopathic pulmonary fibrosis (IPF) develop acute exacerbation (AE-IPF) leading to severe acute respiratory failure (ARF); despite conventional supportive therapy, the mortality rate remains extremely high. The aim of this study was to assess how a treatment algorithm incorporating high-flow nasal cannula (HFNC) oxygen therapy affects the short-term mortality of patients with AE-IPF who develop ARF. Method and design: A retrospective cohort analysis was conducted. Patients and interventions: The study consisted of 17 patients with AE-IPF admitted to a respiratory intensive care unit (RICU) for ARF managed using a treatment algorithm incorporating HFNC. The outcome measure was mortality rate during their stay in the RICU. Results: Implementation of the treatment algorithm led to a successful outcome in nine patients and to a negative one in eight patients (47.1%) who died within 39 days of being admitted to the RICU. The survival rate was 70.6% (±0.1 %) at 15 days, 52.9% (±0.1%) at 30 days, 35.3% (±0.1%) at 90 days, and 15.6% (±9.73 %) at 365 days. Overall, 4 out of 10 patients who did not respond to conventional oxygen therapy showed a satisfactory response to HFNC. Conclusions: Short-term mortality fell to below 50% when a treatment algorithm incorporating HFNC was implemented in a group of patients with AE-IPF admitted to a RICU for ARF. Patients not responding to conventional oxygen therapy seemed to benefit from HFNC. The reviews of this paper are available via the supplementary material section.

Download Full-text

Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0040-1712101 ◽

2020 ◽

Vol 41 (06) ◽

pp. 786-797

Author(s):

Miquel Ferrer ◽

Antoni Torres

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Respiratory Failure ◽

Pulmonary Disease ◽

Noninvasive Ventilation ◽

Work Of Breathing ◽

High Flow ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Hypercapnic Respiratory Failure ◽

Acute Hypercapnic Respiratory Failure

AbstractNoninvasive ventilation (NIV) is considered to be the standard of care for the management of acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease exacerbation. It can be delivered safely in any dedicated setting, from emergency rooms to high dependency or intensive care units and wards. NIV helps improving dyspnea and gas exchange, reduces the need for endotracheal intubation, and morbidity and mortality rates. It is therefore recognized as the gold standard in this condition. High-flow nasal therapy helps improving ventilatory efficiency and reducing the work of breathing in patients with severe chronic obstructive pulmonary disease. Early studies indicate that some patients with acute hypercapnic respiratory failure can be managed with high-flow nasal therapy, but more information is needed before specific recommendations for this therapy can be made. Therefore, high-flow nasal therapy use should be individualized in each particular situation and institution, taking into account resources, and local and personal experience with all respiratory support therapies.

Download Full-text

Nasal high-flow oxygen versus noninvasive ventilation in acute exacerbation of COPD: protocol for a randomised noninferiority clinical trial

ERJ Open Research ◽

10.1183/23120541.00114-2020 ◽

2020 ◽

Vol 6 (4) ◽

pp. 00114-2020

Author(s):

Athanasia Papalampidou ◽

Eleni Bibaki ◽

Stylianos Boutlas ◽

Ioannis Pantazopoulos ◽

Nikolaos Athanasiou ◽

...

Keyword(s):

Respiratory Failure ◽

Noninvasive Ventilation ◽

High Flow ◽

Line Treatment ◽

First Line ◽

Hypercapnic Respiratory Failure ◽

Acute Exacerbation Of Copd ◽

High Flow Oxygen ◽

Exacerbation Of Copd ◽

First Line Treatment

BackgroundNoninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it.AimThe study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure.MethodsWe designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and PaCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain SpO2 between 88%–92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death.ConclusionGiven the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.

Download Full-text

Effectiveness of high flow oxygen therapy (HFNC) in hypercapnic respiratory failure

10.1183/13993003.congress-2020.347 ◽

2020 ◽

Author(s):

Antonio Di Sorbo ◽

Mariano Mazza ◽

Assunta Micco ◽

Angelo Romano ◽

Gaetano Beatrice ◽

...

Keyword(s):

Respiratory Failure ◽

Oxygen Therapy ◽

High Flow ◽

Hypercapnic Respiratory Failure ◽

High Flow Oxygen

Download Full-text

P202 Factors affecting survival-to-discharge in non-COPD patients receiving non-invasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF)

10.1136/thorax-2018-212555.359 ◽

2018 ◽

Author(s):

J Morlet ◽

A James ◽

S Trethewey ◽

A Oakes ◽

A Livesey ◽

...

Keyword(s):

Respiratory Failure ◽

Invasive Ventilation ◽

Factors Affecting ◽

Hypercapnic Respiratory Failure ◽

Non Invasive ◽

Copd Patients ◽

Non Invasive Ventilation ◽

Acute Hypercapnic Respiratory Failure

Download Full-text

Stridor and respiratory failure due to tracheobronchomalacia: case report and review of the literature

Sao Paulo Medical Journal ◽

10.1590/s1516-31802012000100011 ◽

2012 ◽

Vol 130 (1) ◽

pp. 61-64 ◽

Cited By ~ 1

Author(s):

Ramon Andrade de Mello ◽

Adriana Magalhães ◽

Abílio José Vilas-Boas

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Rare Case ◽

Rigid Bronchoscopy ◽

Chronic Obstructive ◽

Review Of The Literature ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

History Of

CONTEXT: Tracheobronchomalacia (TBM) results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of the trachea and main bronchi. In this paper, we present a rare case of a patient with TBM who first presented with stridor and respiratory failure due to exacerbation of chronic bronchitis. CASE REPORT: An 81-year-old Caucasian man was admitted presenting coughing, purulent sputum, stridor and respiratory failure. He had a medical history of chronic obstructive pulmonary disease (COPD) and silicosis and was a former smoker. Axial computed tomography on the chest revealed marked collapse of the trachea in its middle third. Bronchoscopy showed characteristics compatible with TBM. He was treated with noninvasive ventilation, without any good response. Subsequently, a Dumon Y stent was placed by means of rigid bronchoscopy. After the procedure, he was discharged with a clinical improvement. CONCLUSION: TBM is fatal and often underdiagnosed. In COPD patients, stridor and respiratory failure may be helpful signs that should alert physicians to consider TBM as an early diagnosis. Thus, these signs may be important for optimizing the treatment and evolution of such patients.

Download Full-text