高流量鼻插管与无创通气在治疗慢性阻塞性肺疾病急性加重伴急性-中度高碳酸血症呼吸衰竭中的比较

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE
Rongpeng Xu, Ziqiang Shao
{"title":"高流量鼻插管与无创通气在治疗慢性阻塞性肺疾病急性加重伴急性-中度高碳酸血症呼吸衰竭中的比较","authors":"Rongpeng Xu, Ziqiang Shao","doi":"10.1186/s13054-024-05094-9","DOIUrl":null,"url":null,"abstract":"<p>Dear Editor,</p><p>Recently, we read with great interest the article by Tan et al. [1], in which the authors demonstrated that compared to high-flow nasal cannula oxygen (HFNC), non-invasive ventilation (NIV) is a better choice for initial respiratory support in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by acute-moderate hypercapnic respiratory failure. Although this result highlights the efficacy of NIV in the treatment of AECOPD patients, we believe that there are still certain issues that need to be clarified in the study conducted by Tan et al.</p><p>First, the gas flow rate of HFNC during treatment needs to be noticed. Mechanically, the high gas flow rate of HFNC can wash out the dead space of chronic obstructive pulmonary disease (COPD) patients, and effectively decreases pressure of arterial carbon dioxide (PaCO<sub>2</sub>). Studies have shown that HFNC as initial respiratory support is non-inferior to NIV in decreasing PaCO<sub>2</sub> after 2 h of treatment in patients with mild-to-moderate AECOPD [2]. However, carbon dioxide retention was the most common reason for treatment failure in the HFNC group in this study. Therefore, whether raising the initial gas flow rate from 40 L/min to 60 L/min could improve the treatment success rate of HFNC. It is worth noting that study has shown that higher gas flow rate than 30 L/min not only fails to lower PaCO<sub>2</sub> but also increases inspiratory effort [3]. In short, the initial gas flow rate of 40 L/min does not seem to be an optimal setting. In addition, HFNC has the advantage of comfort and is usually used continuously after obtaining the optimal gas flow rate required by the patient. In this study, intermittent downregulation of gas flow rate or even discontinuation of HFNC was adopted in the HFNC group, which may be a key factor leading to the failure of HFNC treatment.</p><p>Additionally, the baseline data lacks of information on the frequency of acute exacerbations in patients. The 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD report noted that that the frequency of previous hospitalizations for acute exacerbations of COPD and concurrent cardiovascular disease comorbidities are associated with poor outcomes in patients [4]. Therefore, it is necessary to list the frequency of acute exacerbations and to describe the cardiovascular comorbidities such as heart failure, hypertension, and arrhythmia in the baseline data, which may significantly affect the success of respiratory therapy in each group of patients.</p><p>Furthermore, Oxygen therapy and ventilatory support are only one part of AECOPD treatment [4]. It is well known that the use of bronchodilators is critical in the treatment of AECOPD. Through dilating the bronchi and bronchioles, bronchodilators not only improve the exchange of oxygen and carbon dioxide, but also facilitate the expulsion of sputum, which is closely related to the success of oxygen therapy. In addition, respiratory infection is the main cause of acute exacerbation of COPD, and reasonable antibiotic use can reduce the risk of treatment failure and the length of hospital stay. Poor respiratory infections can significantly increase airway secretions, lead to sputum blockage, carbon dioxide retention, and result in failure of ventilation support, with treatment outcomes that appear to be independent of the choice of HFNC or NIV for ventilation support. Therefore, the authors should provide information on bronchodilator use and infection status during AECOPD treatment in order to rule out differences in oxygen therapy outcomes.</p><p>Finally, HFNC followed by NIV is common in the clinic. Studies have shown that AECOPD patients who switched to NIV after HFNC treatment failure showed similar clinical outcomes compared to patients with direct NIV [5]. Meanwhile, HFNC after NIV interruption can increase patient comfort and reduce NIV use [6]. Therefore, compared with NIV or HFNC alone, alternating use of both may be a viable ventilation support strategy for AECOPD patients. Unfortunately, most of the existing studies have focused on the non-inferiority of NIV versus HFNC and have produced some conflicting results.</p><p>In conclusion, the non-inferiority of HFNC and NIV in the treatment of AECOPD with acute-moderate hypercapnic respiratory failure remains to be discussed. In addition, future well-designed studies should focus on the role of alternating HFNC and NIV in the treatment of AECOPD patients to avoid intubation.</p><p>No datasets were generated or analysed during the current study.</p><dl><dt style=\"min-width:50px;\"><dfn>HFNC:</dfn></dt><dd>\n<p>High-flow nasal cannula oxygen</p>\n</dd><dt style=\"min-width:50px;\"><dfn>NIV:</dfn></dt><dd>\n<p>Non-invasive ventilation</p>\n</dd><dt style=\"min-width:50px;\"><dfn>AECOPD:</dfn></dt><dd>\n<p>Acute exacerbations of chronic obstructive pulmonary disease</p>\n</dd><dt style=\"min-width:50px;\"><dfn>COPD:</dfn></dt><dd>\n<p>Chronic obstructive pulmonary disease</p>\n</dd><dt style=\"min-width:50px;\"><dfn>PaCO<sub>2</sub> :</dfn></dt><dd>\n<p>Pressure of arterial carbon dioxide</p>\n</dd></dl><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Tan D, Wang B, Cao P, Wang Y, Sun J, Geng P, et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial. Crit Care. 2024;28:250.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"2.\"><p>Cortegiani A, Longhini F, Madotto F, Groff P, Scala R, Crimi C, et al. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial. Crit Care. 2020;24:692.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"3.\"><p>Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study. Ann Intensive Care. 2019;9:122.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"4.\"><p>Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017;49:1700214.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"5.\"><p>Wang M, Zhao F, Sun L, Liang Y, Yan W, Sun X, et al. High-flow nasal cannula versus noninvasive ventilation in AECOPD patients with respiratory acidosis: a retrospective propensity score-matched study. Can Respir J. 2023;2023:6377441.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"6.\"><p>Longhini F, Pisani L, Lungu R, Comellini V, Bruni A, Garofalo E, et al. High-flow oxygen therapy after noninvasive ventilation interruption in patients recovering from hypercapnic acute respiratory failure: a physiological crossover trial. Crit Care Med. 2019;47:e506–11.</p><p>Article CAS PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>None.</p><p>The authors received no funding for this study.</p><h3>Authors and Affiliations</h3><ol><li><p>Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China</p><p>Rongpeng Xu &amp; Ziqiang Shao</p></li></ol><span>Authors</span><ol><li><span>Rongpeng Xu</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Ziqiang Shao</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>RPX and ZQS participated in the discussion and wrote the manuscript. All authors read and approved the final version of the manuscript.</p><h3>Corresponding author</h3><p>Correspondence to Ziqiang Shao.</p><h3>Ethics approval and consent to participate</h3>\n<p>Not applicable.</p>\n<h3>Consent for publication</h3>\n<p>Not applicable.</p>\n<h3>Competing interests</h3>\n<p>The authors declare that they have no competing interests.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>\" width=\"57\"/><h3>Cite this article</h3><p>Xu, R., Shao, Z. High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure. <i>Crit Care</i> <b>28</b>, 313 (2024). https://doi.org/10.1186/s13054-024-05094-9</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2024-08-31\">31 August 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2024-09-10\">10 September 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2024-09-19\">19 September 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05094-9</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\"click\" data-track-action=\"get shareable link\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\"click\" data-track-action=\"select share url\" data-track-label=\"button\"></p><button data-track=\"click\" data-track-action=\"copy share url\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"12 1","pages":""},"PeriodicalIF":8.8000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure\",\"authors\":\"Rongpeng Xu, Ziqiang Shao\",\"doi\":\"10.1186/s13054-024-05094-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Dear Editor,</p><p>Recently, we read with great interest the article by Tan et al. [1], in which the authors demonstrated that compared to high-flow nasal cannula oxygen (HFNC), non-invasive ventilation (NIV) is a better choice for initial respiratory support in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by acute-moderate hypercapnic respiratory failure. Although this result highlights the efficacy of NIV in the treatment of AECOPD patients, we believe that there are still certain issues that need to be clarified in the study conducted by Tan et al.</p><p>First, the gas flow rate of HFNC during treatment needs to be noticed. Mechanically, the high gas flow rate of HFNC can wash out the dead space of chronic obstructive pulmonary disease (COPD) patients, and effectively decreases pressure of arterial carbon dioxide (PaCO<sub>2</sub>). Studies have shown that HFNC as initial respiratory support is non-inferior to NIV in decreasing PaCO<sub>2</sub> after 2 h of treatment in patients with mild-to-moderate AECOPD [2]. However, carbon dioxide retention was the most common reason for treatment failure in the HFNC group in this study. Therefore, whether raising the initial gas flow rate from 40 L/min to 60 L/min could improve the treatment success rate of HFNC. It is worth noting that study has shown that higher gas flow rate than 30 L/min not only fails to lower PaCO<sub>2</sub> but also increases inspiratory effort [3]. In short, the initial gas flow rate of 40 L/min does not seem to be an optimal setting. In addition, HFNC has the advantage of comfort and is usually used continuously after obtaining the optimal gas flow rate required by the patient. In this study, intermittent downregulation of gas flow rate or even discontinuation of HFNC was adopted in the HFNC group, which may be a key factor leading to the failure of HFNC treatment.</p><p>Additionally, the baseline data lacks of information on the frequency of acute exacerbations in patients. The 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD report noted that that the frequency of previous hospitalizations for acute exacerbations of COPD and concurrent cardiovascular disease comorbidities are associated with poor outcomes in patients [4]. Therefore, it is necessary to list the frequency of acute exacerbations and to describe the cardiovascular comorbidities such as heart failure, hypertension, and arrhythmia in the baseline data, which may significantly affect the success of respiratory therapy in each group of patients.</p><p>Furthermore, Oxygen therapy and ventilatory support are only one part of AECOPD treatment [4]. It is well known that the use of bronchodilators is critical in the treatment of AECOPD. Through dilating the bronchi and bronchioles, bronchodilators not only improve the exchange of oxygen and carbon dioxide, but also facilitate the expulsion of sputum, which is closely related to the success of oxygen therapy. In addition, respiratory infection is the main cause of acute exacerbation of COPD, and reasonable antibiotic use can reduce the risk of treatment failure and the length of hospital stay. Poor respiratory infections can significantly increase airway secretions, lead to sputum blockage, carbon dioxide retention, and result in failure of ventilation support, with treatment outcomes that appear to be independent of the choice of HFNC or NIV for ventilation support. Therefore, the authors should provide information on bronchodilator use and infection status during AECOPD treatment in order to rule out differences in oxygen therapy outcomes.</p><p>Finally, HFNC followed by NIV is common in the clinic. Studies have shown that AECOPD patients who switched to NIV after HFNC treatment failure showed similar clinical outcomes compared to patients with direct NIV [5]. Meanwhile, HFNC after NIV interruption can increase patient comfort and reduce NIV use [6]. Therefore, compared with NIV or HFNC alone, alternating use of both may be a viable ventilation support strategy for AECOPD patients. Unfortunately, most of the existing studies have focused on the non-inferiority of NIV versus HFNC and have produced some conflicting results.</p><p>In conclusion, the non-inferiority of HFNC and NIV in the treatment of AECOPD with acute-moderate hypercapnic respiratory failure remains to be discussed. In addition, future well-designed studies should focus on the role of alternating HFNC and NIV in the treatment of AECOPD patients to avoid intubation.</p><p>No datasets were generated or analysed during the current study.</p><dl><dt style=\\\"min-width:50px;\\\"><dfn>HFNC:</dfn></dt><dd>\\n<p>High-flow nasal cannula oxygen</p>\\n</dd><dt style=\\\"min-width:50px;\\\"><dfn>NIV:</dfn></dt><dd>\\n<p>Non-invasive ventilation</p>\\n</dd><dt style=\\\"min-width:50px;\\\"><dfn>AECOPD:</dfn></dt><dd>\\n<p>Acute exacerbations of chronic obstructive pulmonary disease</p>\\n</dd><dt style=\\\"min-width:50px;\\\"><dfn>COPD:</dfn></dt><dd>\\n<p>Chronic obstructive pulmonary disease</p>\\n</dd><dt style=\\\"min-width:50px;\\\"><dfn>PaCO<sub>2</sub> :</dfn></dt><dd>\\n<p>Pressure of arterial carbon dioxide</p>\\n</dd></dl><ol data-track-component=\\\"outbound reference\\\" data-track-context=\\\"references section\\\"><li data-counter=\\\"1.\\\"><p>Tan D, Wang B, Cao P, Wang Y, Sun J, Geng P, et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial. Crit Care. 2024;28:250.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"2.\\\"><p>Cortegiani A, Longhini F, Madotto F, Groff P, Scala R, Crimi C, et al. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial. Crit Care. 2020;24:692.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"3.\\\"><p>Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study. Ann Intensive Care. 2019;9:122.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"4.\\\"><p>Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017;49:1700214.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\\\"5.\\\"><p>Wang M, Zhao F, Sun L, Liang Y, Yan W, Sun X, et al. High-flow nasal cannula versus noninvasive ventilation in AECOPD patients with respiratory acidosis: a retrospective propensity score-matched study. Can Respir J. 2023;2023:6377441.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\\\"6.\\\"><p>Longhini F, Pisani L, Lungu R, Comellini V, Bruni A, Garofalo E, et al. High-flow oxygen therapy after noninvasive ventilation interruption in patients recovering from hypercapnic acute respiratory failure: a physiological crossover trial. Crit Care Med. 2019;47:e506–11.</p><p>Article CAS PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-download-medium\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></p><p>None.</p><p>The authors received no funding for this study.</p><h3>Authors and Affiliations</h3><ol><li><p>Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China</p><p>Rongpeng Xu &amp; Ziqiang Shao</p></li></ol><span>Authors</span><ol><li><span>Rongpeng Xu</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Ziqiang Shao</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>RPX and ZQS participated in the discussion and wrote the manuscript. All authors read and approved the final version of the manuscript.</p><h3>Corresponding author</h3><p>Correspondence to Ziqiang Shao.</p><h3>Ethics approval and consent to participate</h3>\\n<p>Not applicable.</p>\\n<h3>Consent for publication</h3>\\n<p>Not applicable.</p>\\n<h3>Competing interests</h3>\\n<p>The authors declare that they have no competing interests.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\\n<p>Reprints and permissions</p><img alt=\\\"Check for updates. 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High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure. <i>Crit Care</i> <b>28</b>, 313 (2024). https://doi.org/10.1186/s13054-024-05094-9</p><p>Download citation<svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-download-medium\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></p><ul data-test=\\\"publication-history\\\"><li><p>Received<span>: </span><span><time datetime=\\\"2024-08-31\\\">31 August 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\\\"2024-09-10\\\">10 September 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\\\"2024-09-19\\\">19 September 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05094-9</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\\\"click\\\" data-track-action=\\\"get shareable link\\\" data-track-external=\\\"\\\" data-track-label=\\\"button\\\" type=\\\"button\\\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\\\"click\\\" data-track-action=\\\"select share url\\\" data-track-label=\\\"button\\\"></p><button data-track=\\\"click\\\" data-track-action=\\\"copy share url\\\" data-track-external=\\\"\\\" data-track-label=\\\"button\\\" type=\\\"button\\\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>\",\"PeriodicalId\":10811,\"journal\":{\"name\":\"Critical Care\",\"volume\":\"12 1\",\"pages\":\"\"},\"PeriodicalIF\":8.8000,\"publicationDate\":\"2024-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13054-024-05094-9\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13054-024-05094-9","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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高流量鼻插管氧疗与无创通气治疗慢性阻塞性肺病急性加重伴急性-中度高碳酸血症呼吸衰竭:随机对照非劣效性试验。Crit Care.2024;28:250.Article PubMed PubMed Central Google Scholar Cortegiani A, Longhini F, Madotto F, Groff P, Scala R, Crimi C, et al. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial.Crit Care.2020;24:692.Article PubMed PubMed Central Google Scholar Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study.Ann Intensive Care.2019;9:122.Article PubMed PubMed Central Google Scholar Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. 诊断、管理和预防慢性阻塞性肺病全球战略 2017 年报告:GOLD执行摘要。Eur Respir J. 2017;49:1700214.Article PubMed Google Scholar Wang M, Zhao F, Sun L, Liang Y, Yan W, Sun X, et al. High-flow nasal cannula versus noninvasive ventilation in AECOPD patients with respiratory acidosis: a retrospective propensity score-matched study.Can Respir J. 2023;2023:6377441.Article PubMed PubMed Central Google Scholar Longhini F, Pisani L, Lungu R, Comellini V, Bruni A, Garofalo E, et al. 从高碳酸血症急性呼吸衰竭恢复的患者无创通气中断后的高流量氧疗:生理交叉试验。Crit Care Med.2019;47:e506-11.文章 CAS PubMed Google Scholar 下载参考文献无.作者在本研究中未获得任何资助。作者及单位浙江省杭州市上塘路158号浙江省人民医院(杭州医学院附属人民医院)急危重症医学中心重症医学科徐荣鹏&amp;邵自强作者简介徐荣鹏查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者邵自强查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者供稿RPX和ZQS参与了讨论并撰写了手稿。通讯作者邵自强.伦理批准和参与同意书不适用.发表同意书不适用.利益冲突作者声明他们没有利益冲突.出版者注释Springer Nature对出版地图中的管辖权主张和机构隶属关系保持中立。开放获取本文采用知识共享署名-非商业性-禁止衍生 4.0 国际许可协议进行许可,该协议允许以任何媒介或格式进行非商业性使用、共享、分发和复制,只要您适当注明原作者和来源,提供知识共享许可协议的链接,并说明您是否修改了许可材料。根据本许可协议,您无权分享源自本文或本文部分内容的改编材料。本文中的图片或其他第三方材料均包含在文章的知识共享许可协议中,除非在材料的信用栏中另有说明。如果材料未包含在文章的知识共享许可协议中,且您打算使用的材料不符合法律规定或超出了许可使用范围,则您需要直接获得版权所有者的许可。如需查看该许可的副本,请访问 http://creativecommons.org/licenses/by-nc-nd/4.0/.Reprints and permissionsCite this articleXu, R., Shao, Z. High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure.https://doi.org/10.1186/s13054-024-05094-9Download citationReceived:接受:2024 年 8 月 31 日10 September 2024Published: 19 September 2024DOI: https://doi.org/10.1186/s13054-024-05094-9Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative.
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High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure

Dear Editor,

Recently, we read with great interest the article by Tan et al. [1], in which the authors demonstrated that compared to high-flow nasal cannula oxygen (HFNC), non-invasive ventilation (NIV) is a better choice for initial respiratory support in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by acute-moderate hypercapnic respiratory failure. Although this result highlights the efficacy of NIV in the treatment of AECOPD patients, we believe that there are still certain issues that need to be clarified in the study conducted by Tan et al.

First, the gas flow rate of HFNC during treatment needs to be noticed. Mechanically, the high gas flow rate of HFNC can wash out the dead space of chronic obstructive pulmonary disease (COPD) patients, and effectively decreases pressure of arterial carbon dioxide (PaCO2). Studies have shown that HFNC as initial respiratory support is non-inferior to NIV in decreasing PaCO2 after 2 h of treatment in patients with mild-to-moderate AECOPD [2]. However, carbon dioxide retention was the most common reason for treatment failure in the HFNC group in this study. Therefore, whether raising the initial gas flow rate from 40 L/min to 60 L/min could improve the treatment success rate of HFNC. It is worth noting that study has shown that higher gas flow rate than 30 L/min not only fails to lower PaCO2 but also increases inspiratory effort [3]. In short, the initial gas flow rate of 40 L/min does not seem to be an optimal setting. In addition, HFNC has the advantage of comfort and is usually used continuously after obtaining the optimal gas flow rate required by the patient. In this study, intermittent downregulation of gas flow rate or even discontinuation of HFNC was adopted in the HFNC group, which may be a key factor leading to the failure of HFNC treatment.

Additionally, the baseline data lacks of information on the frequency of acute exacerbations in patients. The 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD report noted that that the frequency of previous hospitalizations for acute exacerbations of COPD and concurrent cardiovascular disease comorbidities are associated with poor outcomes in patients [4]. Therefore, it is necessary to list the frequency of acute exacerbations and to describe the cardiovascular comorbidities such as heart failure, hypertension, and arrhythmia in the baseline data, which may significantly affect the success of respiratory therapy in each group of patients.

Furthermore, Oxygen therapy and ventilatory support are only one part of AECOPD treatment [4]. It is well known that the use of bronchodilators is critical in the treatment of AECOPD. Through dilating the bronchi and bronchioles, bronchodilators not only improve the exchange of oxygen and carbon dioxide, but also facilitate the expulsion of sputum, which is closely related to the success of oxygen therapy. In addition, respiratory infection is the main cause of acute exacerbation of COPD, and reasonable antibiotic use can reduce the risk of treatment failure and the length of hospital stay. Poor respiratory infections can significantly increase airway secretions, lead to sputum blockage, carbon dioxide retention, and result in failure of ventilation support, with treatment outcomes that appear to be independent of the choice of HFNC or NIV for ventilation support. Therefore, the authors should provide information on bronchodilator use and infection status during AECOPD treatment in order to rule out differences in oxygen therapy outcomes.

Finally, HFNC followed by NIV is common in the clinic. Studies have shown that AECOPD patients who switched to NIV after HFNC treatment failure showed similar clinical outcomes compared to patients with direct NIV [5]. Meanwhile, HFNC after NIV interruption can increase patient comfort and reduce NIV use [6]. Therefore, compared with NIV or HFNC alone, alternating use of both may be a viable ventilation support strategy for AECOPD patients. Unfortunately, most of the existing studies have focused on the non-inferiority of NIV versus HFNC and have produced some conflicting results.

In conclusion, the non-inferiority of HFNC and NIV in the treatment of AECOPD with acute-moderate hypercapnic respiratory failure remains to be discussed. In addition, future well-designed studies should focus on the role of alternating HFNC and NIV in the treatment of AECOPD patients to avoid intubation.

No datasets were generated or analysed during the current study.

HFNC:

High-flow nasal cannula oxygen

NIV:

Non-invasive ventilation

AECOPD:

Acute exacerbations of chronic obstructive pulmonary disease

COPD:

Chronic obstructive pulmonary disease

PaCO2 :

Pressure of arterial carbon dioxide

  1. Tan D, Wang B, Cao P, Wang Y, Sun J, Geng P, et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a randomized controlled non-inferiority trial. Crit Care. 2024;28:250.

    Article PubMed PubMed Central Google Scholar

  2. Cortegiani A, Longhini F, Madotto F, Groff P, Scala R, Crimi C, et al. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial. Crit Care. 2020;24:692.

    Article PubMed PubMed Central Google Scholar

  3. Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study. Ann Intensive Care. 2019;9:122.

    Article PubMed PubMed Central Google Scholar

  4. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017;49:1700214.

    Article PubMed Google Scholar

  5. Wang M, Zhao F, Sun L, Liang Y, Yan W, Sun X, et al. High-flow nasal cannula versus noninvasive ventilation in AECOPD patients with respiratory acidosis: a retrospective propensity score-matched study. Can Respir J. 2023;2023:6377441.

    Article PubMed PubMed Central Google Scholar

  6. Longhini F, Pisani L, Lungu R, Comellini V, Bruni A, Garofalo E, et al. High-flow oxygen therapy after noninvasive ventilation interruption in patients recovering from hypercapnic acute respiratory failure: a physiological crossover trial. Crit Care Med. 2019;47:e506–11.

    Article CAS PubMed Google Scholar

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The authors received no funding for this study.

Authors and Affiliations

  1. Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Shangtang Road 158, Hangzhou, 310014, Zhejiang, China

    Rongpeng Xu & Ziqiang Shao

Authors
  1. Rongpeng XuView author publications

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  2. Ziqiang ShaoView author publications

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Contributions

RPX and ZQS participated in the discussion and wrote the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Ziqiang Shao.

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Xu, R., Shao, Z. High flow nasal cannula versus non-invasive ventilation in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure. Crit Care 28, 313 (2024). https://doi.org/10.1186/s13054-024-05094-9

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来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
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