High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study
BackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently present with acute hypercapnic respiratory failure (AHRF). While non-invasive ventilation (NIV) remains the fist-line therapy, high-flow nasal cannula (HFNC) offers a potential alternative.MethodsThis retrospe...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-06-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1582749/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849422493228466176 |
|---|---|
| author | Nicolás Colaianni-Alfonso Ada Toledo Guillermo Montiel Cristian Deana Luigi Vetrugno Mauro Castro-Sayat |
| author_facet | Nicolás Colaianni-Alfonso Ada Toledo Guillermo Montiel Cristian Deana Luigi Vetrugno Mauro Castro-Sayat |
| author_sort | Nicolás Colaianni-Alfonso |
| collection | DOAJ |
| description | BackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently present with acute hypercapnic respiratory failure (AHRF). While non-invasive ventilation (NIV) remains the fist-line therapy, high-flow nasal cannula (HFNC) offers a potential alternative.MethodsThis retrospective cohort study compared the clinical effectiveness and safety of HFNC versus NIV as initial respiratory support in 100 consecutive patients with AECOPD and AHRF (PaCO2 > 45 mmHg, pH 7.25–7.35). Patients were categorized into HFNC and NIV groups based on the respiratory support initiated within the first 2 h of admission. The primary outcome was treatment failure, defined as intubation, switch from one non-invasive respiratory support to another or death under NIRS. Secondary outcomes included respiratory rate (RR), arterial blood gas parameters, length of stay, and duration of respiratory support.ResultsTreatment failure rates were comparable between the HFNC (32%) and NIV (35%) groups (p = 0.72). However, reasons for treatment escalation differed significantly. NIV failure was largely due to intolerance, while HFNC failure was associated with worsening respiratory distress or hypercapnia. NIV demonstrated superior early improvements in RR and PaCO2 compared to HFNC. No statistically significant differences were found in length of stay or 28-day mortality.ConclusionThis study suggests similar overall treatment success rates for HFNC and NIV in AECOPD with AHRF. However, NIV appears more effective in achieving early respiratory improvements, whereas HFNC offers superior tolerability. Further large-scale, prospective, randomized controlled trials are warranted to definitively establish optimal respiratory support strategies for this patient population. |
| format | Article |
| id | doaj-art-75707eba5e844fdebf8963cd58e68643 |
| institution | Kabale University |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-75707eba5e844fdebf8963cd58e686432025-08-20T03:31:02ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-06-011210.3389/fmed.2025.15827491582749High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective studyNicolás Colaianni-Alfonso0Ada Toledo1Guillermo Montiel2Cristian Deana3Luigi Vetrugno4Mauro Castro-Sayat5Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Buenos Aires, ArgentinaRespiratory Intermediate Care Unit, Hospital Juan A. Fernández, Buenos Aires, ArgentinaRespiratory Intermediate Care Unit, Hospital Juan A. Fernández, Buenos Aires, ArgentinaDepartment of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, ItalyDepartment of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, ItalyRespiratory Intermediate Care Unit, Hospital Juan A. Fernández, Buenos Aires, ArgentinaBackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently present with acute hypercapnic respiratory failure (AHRF). While non-invasive ventilation (NIV) remains the fist-line therapy, high-flow nasal cannula (HFNC) offers a potential alternative.MethodsThis retrospective cohort study compared the clinical effectiveness and safety of HFNC versus NIV as initial respiratory support in 100 consecutive patients with AECOPD and AHRF (PaCO2 > 45 mmHg, pH 7.25–7.35). Patients were categorized into HFNC and NIV groups based on the respiratory support initiated within the first 2 h of admission. The primary outcome was treatment failure, defined as intubation, switch from one non-invasive respiratory support to another or death under NIRS. Secondary outcomes included respiratory rate (RR), arterial blood gas parameters, length of stay, and duration of respiratory support.ResultsTreatment failure rates were comparable between the HFNC (32%) and NIV (35%) groups (p = 0.72). However, reasons for treatment escalation differed significantly. NIV failure was largely due to intolerance, while HFNC failure was associated with worsening respiratory distress or hypercapnia. NIV demonstrated superior early improvements in RR and PaCO2 compared to HFNC. No statistically significant differences were found in length of stay or 28-day mortality.ConclusionThis study suggests similar overall treatment success rates for HFNC and NIV in AECOPD with AHRF. However, NIV appears more effective in achieving early respiratory improvements, whereas HFNC offers superior tolerability. Further large-scale, prospective, randomized controlled trials are warranted to definitively establish optimal respiratory support strategies for this patient population.https://www.frontiersin.org/articles/10.3389/fmed.2025.1582749/fullacute hypercapnic respiratory failureCOPDnon-invasive ventilationhigh-flow nasal cannulanon-invasive respiratory support (NIRS) |
| spellingShingle | Nicolás Colaianni-Alfonso Ada Toledo Guillermo Montiel Cristian Deana Luigi Vetrugno Mauro Castro-Sayat High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study Frontiers in Medicine acute hypercapnic respiratory failure COPD non-invasive ventilation high-flow nasal cannula non-invasive respiratory support (NIRS) |
| title | High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study |
| title_full | High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study |
| title_fullStr | High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study |
| title_full_unstemmed | High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study |
| title_short | High-flow nasal cannula versus non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: a retrospective study |
| title_sort | high flow nasal cannula versus non invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease with acute moderate hypercapnic respiratory failure a retrospective study |
| topic | acute hypercapnic respiratory failure COPD non-invasive ventilation high-flow nasal cannula non-invasive respiratory support (NIRS) |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1582749/full |
| work_keys_str_mv | AT nicolascolaiannialfonso highflownasalcannulaversusnoninvasiveventilationforacuteexacerbationsofchronicobstructivepulmonarydiseasewithacutemoderatehypercapnicrespiratoryfailurearetrospectivestudy AT adatoledo highflownasalcannulaversusnoninvasiveventilationforacuteexacerbationsofchronicobstructivepulmonarydiseasewithacutemoderatehypercapnicrespiratoryfailurearetrospectivestudy AT guillermomontiel highflownasalcannulaversusnoninvasiveventilationforacuteexacerbationsofchronicobstructivepulmonarydiseasewithacutemoderatehypercapnicrespiratoryfailurearetrospectivestudy AT cristiandeana highflownasalcannulaversusnoninvasiveventilationforacuteexacerbationsofchronicobstructivepulmonarydiseasewithacutemoderatehypercapnicrespiratoryfailurearetrospectivestudy AT luigivetrugno highflownasalcannulaversusnoninvasiveventilationforacuteexacerbationsofchronicobstructivepulmonarydiseasewithacutemoderatehypercapnicrespiratoryfailurearetrospectivestudy AT maurocastrosayat highflownasalcannulaversusnoninvasiveventilationforacuteexacerbationsofchronicobstructivepulmonarydiseasewithacutemoderatehypercapnicrespiratoryfailurearetrospectivestudy |