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

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.

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

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.

High-Flow Oxygen vs Noninvasive Ventilation for Postextubation Respiratory Failure—Reply

JAMA ◽  
2017 ◽  
Vol 317 (8) ◽  
pp. 855
Author(s):  
Gonzalo Hernández ◽  
Laura Colinas ◽  
Alfonso Canabal
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
High Flow ◽  
High Flow Oxygen

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

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

scholarly journals Effectiveness of non-invasive positive pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease

2018 ◽  
Vol 5 (2) ◽  
pp. 102 ◽  
Author(s):  
Bhavani Mohan Raju ◽  
Sushma Jotkar ◽  
Prathyusha M. ◽  
Shraddha Goswami ◽  
Mukesh Dube ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Exacerbation ◽  
Standard Therapy ◽  
Clinical Status ◽  
Invasive Ventilation ◽  
Hypercapnic Respiratory Failure ◽  
Acute Exacerbation Of Copd ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Exacerbation Of Copd

<p class="abstract"><strong>Background:</strong> In patients with acute exacerbations of COPD, endotracheal intubation and complications associated with mechanical ventilation may be evaded using non-invasive ventilation.<strong> </strong>The aim of the study was to analyse the effectiveness of NPPV for hypercapnic respiratory failure secondary to acute exacerbation of COPD in India.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 63 cases of hypercapnic respiratory failure secondary to acute exacerbation of COPD admitted in the intensive care unit during 2011-13 formed the study population. Standard therapy was initiated in all the patients. Patients who failed to improve with standard therapy alone were given a trial of non invasive ventilation. Non invasively ventilated patients, showing significantly improvement in their clinical status and arterial blood gas parameters were discharged. Patients who failed to show significant improvement with NPPV were given invasive ventilation.</p><p class="abstract"><strong>Results:</strong> Standard therapy was initiated in 63 patients on admission but 25 patients failed to improve with standard therapy alone. Out of the total 25 patients non invasively ventilated, 22 patients showed significantly improvement. Significant improvement in the Mean pH, Mean paCO2 and Mean paHCO3 in both standard therapy and non invasive ventilation group. Success rate was found to be highest (88%) in standard therapy + noninvasive ventilation treatment modality group.</p><p class="abstract"><strong>Conclusions: </strong>NIV is an effective tool in hypercapnic respiratory failure secondary to acute exacerbation of COPD and its early initiation would improve the clinical status and respiratory acidosis.</p>

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