HFNC and Acute Hypercapnic Respiratory Failure

Argentinian Intensive Care Society40 enrolled

Overview

High-flow nasal cannula (HFNC) enables delivering humidified gas at high-flow rates controlling the oxygen inspired fraction (FiO2). Its efficacy has been demonstrated in hypoxemic acute respiratory failure. However, little is known about its use in hypercapnic acute respiratory failure (ARF). Therefore, we aimed to evaluate the effect of using HFNC through "Precision Flow" equipment as first line of ventilatory support for COPD patients with hypercapnic acute respiratory failure.

Study Type

OBSERVATIONAL

Enrollment

Conditions

High Flow Oxygen Therapy Acute Hypercapnic Respiratory Failure COPD Exacerbation

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Moderate to very severe COPD patients (GOLD 2 to 4) over 18 years old admitted to the ICU with hypercapnic ARF (PaCO2\> 45 mmHg and respiratory acidosis \[pH ≥7.30\], with or without hypoxemia + one of the following: Respiratory Rate ≥25 cycles per minute, intercostal and / or supraclavicular recruitment, or thoraco-abdominal synchrony, no prior use of NIV) Exclusion Criteria: * Patients less than 18 years old * Mild COPD patients * Absence of hypercapnia * Kelly M Score \> 3 * Haemodynamic instability (despite fluid resuscitation) * NIV or Invasive Mechanical Ventilation (IMV) (Need to use previously to HFNC) * Contraindications to implement high-flow oxygen therapy.

Locations (1)

Sanatorio Anchorena

CABA, Argentina

Outcomes

Primary Outcomes

Need for non-invasive ventilation

The need and causes for non-invasive ventilation will be recorded in the all study period.

Time frame: From inclussion study date until the first day of noninvasive ventilation use documented, after high flow oxygen therapy use or death date from any cause, whichever came first, assessed up to 4 weeks.

Need for endotracheal intubation

The need and causes for endotracheal intubation will be recorded in the all study period.

Time frame: From inclussion study date until the first day of endotracheal intubation documented, after high flow oxygen therapy use or death date from any cause, whichever came first, assessed up to 4 weeks.

Secondary Outcomes

Gas Exchange

pH will be recorded

Time frame: Arterial blood gases will be recorded 1, 24 hours and every 24 hours after enrollment

Gas Exchange

PaCO2 in milimeters of mercury (mmHg) will be recorded

Time frame: Arterial blood gases will be recorded 1, 24 hours and every 24 hours after enrollment

Gas Exchange

PaO2 in milimeters of mercury (mmHg) will be recorded

Time frame: Arterial blood gases will be recorded 1, 24 hours and every 24 hours after enrollment

Respiratory variables

Respiratory rate in numbers of breaths per minute (bpm) will be recorded

Time frame: Respiratory variables will be recorded at 1, 2, 3, 6, 12, 24 hours and every 24 hours after enrollment

Respiratory variables

Data from ClinicalTrials.gov

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