High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study

PLoS One. 2022 Oct 5;17(10):e0272372. doi: 10.1371/journal.pone.0272372. eCollection 2022.

Abstract

Background: The use of High-flow nasal cannula (HFNC) is increasing in admitted COPD-patients and could provide a step in between non-invasive ventilation (NIV) and standard oxygen supply. Recent studies demonstrated that HFNC is capable of facilitating secretion removal and reduce the work of breathing. Therefore, it might be of advantage in the treatment of acute exacerbations of COPD (AECOPD). No randomized trials have assessed this for admitted COPD-patients on a regular ward and only limited data from non-randomized studies is available.

Objectives: The aim of our study was to identify the reasons to initiate treatment with HFNC in a group of COPD-patients during an exacerbation, further identify those most likely to benefit from HFNC treatment and to find factors associated with treatment success on the pulmonary ward.

Material and methods: This retrospective study included COPD-patients admitted to the pulmonary ward and treated with HFNC from April 2016 until April 2019. Only patients admitted with severe acute exacerbations were included. Patients who had an indication for NIV-treatment where treated with NIV and were included only if they subsequently needed HFNC, e.g. when they did not tolerate NIV. Known asthma patients were excluded.

Results: A total of 173 patients were included. Stasis of sputum was the indication most reported to initiate HFNC-treatment. Treatment was well tolerated in 83% of the patients. Cardiac and vascular co-morbidities were significantly associated with a smaller chance of successful treatment (Respectively OR = 0.435; p = 0.013 and OR = 0.493;p = 0.035). Clinical assessment judged HFNC-treatment to be successful in 61% of the patients. Furthermore, in-hospital treatment with NIV was associated with a higher chance of HFNC failure afterwards (OR = 0.439; p = 0.045).

Conclusion: This large retrospective study showed that HFNC-treatment in patients with an AECOPD was initiated most often for sputum stasis as primary reason. Factors associated with improved outcomes of HFNC-treatment was the absence of vascular and/or cardiac co-morbidities and no need for in-hospital NIV-treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cannula
  • Humans
  • Noninvasive Ventilation*
  • Oxygen
  • Oxygen Inhalation Therapy / adverse effects
  • Pulmonary Disease, Chronic Obstructive* / etiology
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Respiratory Insufficiency* / therapy
  • Retrospective Studies

Substances

  • Oxygen

Grants and funding

MD reports grants from Fisher and Paykel LtD (High-TeC trial funded by a public-private partnership of Health-Holland/Dutch Lung Foundation, with co-funding of Fisher and Paykel LtD, and Vivisol BV; registered at ClinicalTrials.gov NCT03564236); grants and personal fees from Vivisol BV (High-TeC trial funded by a public-private partnership of Health-Holland/Dutch Lung Foundation, with co-funding of Fisher and Paykel LtD, and Vivisol BV; registered at ClinicalTrials.gov NCT03564236), grants and personal fees from RESMED LtD (RECAPTURE trial, ClinicalTrials.gov Identifier: NCT03053973), grants and personal fees from Philips BV (RECONSIDER trial funded by the Dutch Lung Foundation with in-kind co-funding of Philips (Longfonds grant nr 5.2.15.057JO, registered at ClinicalTrials.gov NCT02652559), outside the submitted work. The funders did not play any role in study design, data collection and analysis."