Respiratory failure & ventilation
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
Primary resultResult — go to the resultRisk difference 11.38% 95% CI 0.25–21.20Authors' conclusion
HFNC was not shown to be non-inferior to NIV and resulted in a higher incidence of treatment failure than NIV when used as the initial respiratory support for AECOPD patients with acute-moderate hypercapnic respiratory failure.
Study context
- Population
- Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with acute-moderate hypercapnic respiratory failure (pH 7.25–7.35, PaCO2 ≥ 50 mmHg) admitted to two intensive care units (ICUs) of a tertiary academic hospital, March 2018–December 2022ITT analysis
- Participants
- 225 patients
- Comparison
- HFNC vs non-invasive ventilation (NIV) as initial respiratory support
- HFNCn = 113
- NIVn = 112reference
- Primary endpoint
- Treatment failure (endotracheal intubation or switch to the other study treatment modality)
Methodological detailsopen label, non-inferiority
- Open label
- Non-inferiority
Primary result
As reported in the abstract
Risk difference
11.38%
95% CI 0.25–21.20
P = 0.033
By group
HFNC vs NIV
risk difference 11.38% (95% CI 0.25–21.20); P = 0.033
Secondary outcomes
| Outcome | HFNC | NIV | Risk difference (95% CI) | |
|---|---|---|---|---|
| Treatment failure, per-protocol analysis | 25.5% | 13.8% | 11.69% (0.48–22.60) | |
| −100102030Difference (linear scale) |
Intubation rate
P = 0.026
- Treatment failure, per-protocol analysis: per-protocol: 110 HFNC, 109 NIV
Treatment switch rate, ICU and hospital LOS, 28-day mortality
- Not statistically different between HFNC and NIV (all P > 0.05)
Original publication
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. Published 18 July 2024. doi:10.
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