High-Flow Oxygen Therapy Application in Chronic Obstructive Pulmonary Disease Patients With Acute Hypercapnic Respiratory Failure: A Multicenter Study
Gustavo Plotnikow, Matías Accoce, Sebastián Fredes, Norberto Tiribelli, Mariano Setten, Javier Hernán Dorado, María Guaymas, Santiago Ilutovich, Pablo Rodríguez, Cristián Emanuel Cesio, José Luis Scapellato, Daniela N. Vásquez
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 Pa co 2 (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 Pa co 2 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.