Summary: High-flow oxygen therapy application in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure: a multicenter study.
Topic: Primary Support
Plotnikow GA, Accoce M, Fredes S, Tiribelli N, Setten M, Dorado J, et al. High-flow oxygen therapy application in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure: a multicenter study. Crit Care Explor. (2021) 3:e0337. doi: 10.1097/CCE.0000000000000337
Plotnikow et al. in a 2021 multi-center observational case series sought to evaluate high velocity therapy as a first-line ventilation support in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. As a secondary objective, the study aimed to determine possible changes in the clinical signs of respiratory failure and in blood gas exchange, and the presence of predictors for success or failure of treatment. The study included 40 Patients, ages 68±10 years, with a median (IQR) Simplified Acute Physiology Score (SAPS) II score of 28 (21 to 36). The majority of patients, 62.5%, had severe COPD (n=25) with mixed acute exacerbation etiology. High velocity therapy was started at a flow rate of 40 L/min and FiO2 of 1.0, which was titrated targeting an SaO2 of 88-92%. Flow rate and temperature were adjusted to the patient’s work of breathing, comfort, and tolerance. Patient management also included pharmacological treatment as usual for acute hypercapnic respiratory failure. The patient was reevaluated after one hour of high velocity therapy. The results showed that high velocity therapy was an effective tool in reducing respiratory rate and significantly reducing PaCO2 in these patients. There was a 27% decrease of respiratory rate (RR), 59% decrease in accessory muscle use and 9% decrease in PaCO2 during the first hour of treatment.
High velocity therapy was successful as supportive treatment in 83% of cases. The failure in seven patients (17%), is similar to that reported for noninvasive mechanical ventilation (NIMV) used for this patient population1, requiring NIMV within a median of 12 (1 – 36) hours; one progressing to invasive mechanical ventilation.
High-flow oxygen therapy through nasal cannula delivered using high velocity therapy was an effective tool for reducing respiratory rate in these COPD patients with acute hypercapnic respiratory failure. The authors note that early determination and subsequent monitoring of clinical and blood gas parameters may help predict the patient outcome, and that the use of HVNI as supportive treatment in COPD patients with acute hypercapnic respiratory failure warrants further randomized study comparing it to NIMV.
1.) Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995; 333: 817-822.
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High Velocity Therapy in Critical Care