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. 2021 Feb 12;3(2):e0337.
doi: 10.1097/CCE.0000000000000337. eCollection 2021 Feb.

High-Flow Oxygen Therapy Application in Chronic Obstructive Pulmonary Disease Patients With Acute Hypercapnic Respiratory Failure: A Multicenter Study

Gustavo A Plotnikow  1 , Matias Accoce  2 , Sebastián Fredes  3   4 , Norberto Tiribelli  4 , Mariano Setten  5 , Javier Dorado  2 , Maria Guaymas  4 , Santiago Ilutovich  3 , Pablo O Rodriguez  5 , Cristian E Cesio  2 , Jose L Scapellato  1 , Daniela N Vasquez  1
Affiliations

High-Flow Oxygen Therapy Application in Chronic Obstructive Pulmonary Disease Patients With Acute Hypercapnic Respiratory Failure: A Multicenter Study

Gustavo A Plotnikow et al. Crit Care Explor. .

Erratum in

Abstract

Objectives: To evaluate the effect of high-flow oxygen implementation on the respiratory rate as a first-line ventilation support in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure.

Design: Multicenter, prospective, analytic observational case series study.

Setting: Five ICUs in Argentina, between August 2018 and September 2019.

Patients: Patients greater than or equal to 18 years old with moderate to very severe chronic obstructive pulmonary disease, who had been admitted to the ICU with a diagnosis of hypercapnic acute respiratory failure, were entered in the study.

Interventions: High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation.

Measurements and main results: Forty patients were studied, 62.5% severe chronic obstructive pulmonary disease. After the first hour of high-flow nasal cannula implementation, there was a significant decrease of respiratory rate compared with baseline values, with a 27% decline (29 vs 21 breaths/min; p < 0.001). Furthermore, a significant reduction of Paco2 (57 vs 52 mm Hg [7.6 vs 6.9 kPa]; p < 0.001) was observed. The high-flow nasal cannula application failed in 18% patients. In this group, the respiratory rate, pH, and Paco2 showed no significant change during the first hour in these patients.

Conclusions: High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation was an effective tool for reducing respiratory rate in these chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. Early determination and subsequent monitoring of clinical and blood gas parameters may help predict the outcome.

Keywords: acute respiratory failure; chronic obstructive pulmonary disease; chronic obstructive pulmonary disease exacerbation; high-flow oxygen therapy.

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Conflict of interest statement

Mr. Plotnikow reports receiving payment for consulting Vapotherm, Exeter, NH, not directly pertaining to the work presented herein. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Respiratory rate (RR) over time (†p < 0.001 for all measurements compared with baseline). HVNI = high-velocity nasal insufflation.
Figure 2.
Figure 2.
Paco2 and pH over time (†p < 0.001 compared with baseline). HVNI = high-velocity nasal insufflation.
Figure 3.
Figure 3.
Evolution of clinical patterns. A, Total number of patients exhibiting use of accessory muscles recruitment to breathe, comparing baseline to the first hour from start of high-flow oxygen therapy (†p < 0.001 compared with baseline). B, Total number of patients with thoracoabdominal (TA) asynchrony, comparing baseline to the first hour from start of high-flow oxygen therapy (†p < 0.001 compared with baseline). HVNI = high-velocity nasal insufflation.
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