Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD

Professor: Ulla Møller Weinreich 

Artikel link | DOI | PubMed | Journal: Int J Chron Obstruct Pulmon DisI Dato: 2019 Juli

Kommentar til artiklen:

Hjemme-NIV er efterhånden en veletableret behandling med henblik på bedring af livskvalitet og reduktion i antallet af exacerbationer hos patienter med KOL og kronisk hyperkapnisk svigt. Der er dog patienter, som ikke tolererer denne behandling; denne artikel indikerer at High Flow er et potentielt alternativ. Der er tale om en kort behandlingsperiode, så derfor er der stadig behov for længerevarende studier for at bekræfte dette. Ligeledes skal det videre undersøges, om High Flow er effektivt i alle sværhedsgrader af hyperkapni.

Abstract

Background: Despite the encouraging results of noninvasive ventilation (NIV) in chronichypercapnic COPD patients, it is also evident that some patients do not tolerate NIVor do notbenefit from it. We conducted a study in which COPD patients with stable, chronic hypercapniawere treated with NIV and nasal high-flow (NHF) to compare effectiveness.

Methods: In a multi-centered, randomized, controlled, cross-over design, patients received 6weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO)between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO2≥50 mmHg)were recruited from 13 German centers. The primary endpoint was pCO2 changes from baselineblood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device usewere secondary endpoints.

Results: A total of 102 patients (mean±SD) age 65.3±9.3 years, 61% females, body massindex 23.1±4.8 kg/m2, 90% GOLD D, pCO2 56.5±5.4 mmHg were randomized. PCO2 levelsdecreased by 4.7% (n=94; full analysis set; 95% CI 1.8–7.5, P=0.002) using NHF and 7.1%(95% CI 4.1–10.1, P<0.001) from baseline using NIV (indistinguishable to intention-to-treatanalysis). The difference of pCO2 changes between the two devices was −1.4 mmHg (95% CI−3.1–0.4, P=0.12). Both devices had positive impact on blood gases and respiratory scores(St. George’s Respiratory Questionnaire, Severe Respiratory Insufficiency Questionnaire).

Conclusions: NHF may constitute an alternative to NIV in COPD patients with stablechronic hypercapnia, eg, those not tolerating or rejecting NIV with respect to pCO2 reductionand improvement in QoL.