AECOPD
Trial question
Is high-flow nasal cannula superior to conventional oxygen therapy in patients with acute COPD exacerbation and mild hypercapnia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
16.0% female
84.0% male
N = 330
330 patients (53 female, 277 male)
Inclusion criteria: patients with acute COPD exacerbation and mild hypercapnia
Key exclusion criteria: age > 85 years; GCS score < 12; obstructive sleep apnea syndrome; excessive airway secretions difficult to drain; hemodynamic instability; severe arrhythmia or acute coronary syndrome; respiratory and cardiac arrest
Interventions
N=158 high-flow nasal cannula (oxygen flow rate set at 25-60 L/min)
N=172 conventional oxygen therapy (oxygen flow rate set at 1-5 L/min)
Primary outcome
Patients who needed intubation
2.5
0.6
2.5 %
1.9 %
1.3 %
0.6 %
0.0 %
High-flow nasal cannula
Conventional oxygen therapy
No significant difference ↔
No significant difference in patients who needed intubation (2.5% vs. 0.6%; AD 1.95%, 95% CI -0.8 to 4.7)
Secondary outcomes
No significant difference in noninvasive positive pressure ventilation (9.5% vs. 12.8%; ARD -3.3, 95% CI -10.1 to 3.5)
Significant increase in length of hospital stay (9 days vs. 8 days; AD 1 days, 95% CI 0 to 2)
No significant difference in treatment failure (15.8% vs. 14.5%; AD 1.29%, 95% CI -6.5 to 9)
Safety outcomes
No significant differences in death in the hospital, re-admission to the hospital.
Conclusion
In patients with acute COPD exacerbation and mild hypercapnia, high-flow nasal cannula was not superior to conventional oxygen therapy with respect to patients who needed intubation.
Reference
Jingen Xia, Sichao Gu, Wei Lei et al. High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial. Crit Care. 2022 Apr 15;26(1):109.
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