Comparison of HFNC With NIV in Weaning COPD

Jie Li42 enrolled

Overview

High flow nasal cannula (HFNC) has been shown to improve oxygenation and facilitate weaning in hypoxemia patients. Some clinical studies show the benefits of using HFNC in COPD patients, including reducing dead space and work of breathing. However, no clinical study has been to investigate the value of HFNC in weaning COPD patients from invasive ventilation. Thus, we proposed a randomized controlled trial to compare the use of HFNC and noninvasive ventilation (NIV) in weaning COPD.

High flow nasal cannula (HFNC) provides high concentration oxygen in a high flow, which exceeds patient's inspiratory flow demand, to improve oxygenation. In a recent meta-analysis of seven trials with 1771 patients, HFNC was shown to improve oxygenation and avoid intubation in patients with severe hypoxemia. The high velocity of the gas can rinse the dead space of the upper airway and reduce CO2 rebreathing, reduce COPD patients' work of breathing and improve the dynamic compliance of respiratory system. Thus, we proposed a randomized controlled trial to investigate the value of high flow nasal cannula in weaning AECOPD patients from invasive ventilation, with comparison of noninvasive ventilation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Chronic Obstructive Pulmonary Disease With (Acute) Exacerbation

Interventions

High flow nasal cannulaDEVICE

High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas. HFNC is simpler to use and apply than noninvasive ventilation (NIV) and appears to be a good alternative treatment for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO2), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF.

Noninvasive ventilationDEVICE

Non-invasive ventilation (NIV) is the use of airway support administered through a face (nasal) mask instead of an endotracheal tube. Inhaled gases are given with positive end-expiratory pressure often with pressure support or with assist control ventilation at a set tidal volume and rate. Numerous studies have shown this technique to be as effective as, and better tolerated than, intubation and mechanical ventilation in patients with exacerbations of COPD

Eligibility

Sex: ALLMin age: 21 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Intubated patients with Chronic obstructive pulmonary disease exacerbation * Meeting extubation criteria (Pulmonary infection control window) * Age \> 21years and \< 90 years Exclusion Criteria: * Tracheotomy * Combined with severe dysfunction of other organs, including heart, brain, liver, and renal failure; * Hemodynamic instability * Contraindication to NIV: cannot use mask, such as facial injury, burns or deformities; cannot cooperate with NIV such as delirium; copious secretions with weak cough ability; gastric over distention, and vomiting; * Contraindication to HFNC: rhinitis, nasal congestion, deformities or blockage. * Weak cough ability with copious secretions * Refuse to participate in the study

Locations (1)

Binzhou Medical University Hospital

Yantai, Shandong, China

Outcomes

Primary Outcomes

Time frame: change from the baseline pH within 48 hours

PaCO2

PaCO2 in mmHg

Time frame: change from the baseline PaCO2 within 48 hours

PaO2/FiO2

partial pressure of oxygen in arterial blood/ fraction of inspired oxygen in mmHg

Time frame: change from the baseline PaO2/FiO2 within 48 hours

Heart Rate in beats per minute

Time frame: change from the baseline HR within 48 hours

MAP

mean arterial pressure in mmHg

Time frame: change from the baseline MAP within 48 hours

respiratory rate in breaths per minute

Time frame: change from the baseline RR within 48 hours

Secondary Outcomes

duration of respiratory support

hours of ventilator use

Time frame: 28 days

Length of ICU stay

Days of stay in ICU

Time frame: 28 days

Mortality

Time frame: 28 days

the patients' comfort score

comfort score of using high flow nasal cannula or noninvasive ventilator, ranging from 1 to 10. 1 means very comfortable, 10 means very uncomfortable.

Data from ClinicalTrials.gov

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