Background: High-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain. Methods: This randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in China. Patients with acute COPD exacerbation with mild hypercapnia (pH >= 7.35 and arterial partial pressure of carbon dioxide >45 mmHg) were randomly assigned to either HFNC or conventional oxygen therapy. The primary outcome was the proportion of patients who met the criteria for intubation during hospitalization. Secondary outcomes included treatment failure (intolerance and need for non-invasive or invasive ventilation), length of hospital stay, hospital cost, mortality, and readmission at day 90. Results: Among 337 randomized patients (median age, 70.0 years; 280 men [83.1%]; median pH 7.399; arterial partial pressure of carbon dioxide 51 mmHg), 330 completed the trial. 4/158 patients on HFNC and 1/172 patient on conventional oxygen therapy met the criteria for intubation (P = 0.198). Patients progressed to NPPV in both groups were comparable (15 [9.5%] in the HFNC group vs. 22 [12.8%] in the conventional oxygen therapy group; P = 0.343). Compared with conventional oxygen therapy, HFNC yielded a significantly longer median length of hospital stay (9.0 [interquartile range, 7.0-13.0] vs. 8.0 [interquartile range, 7.0-11.0] days) and a higher median hospital cost (approximately $2298 [interquartile range, $1613-$3782] vs. $2005 [interquartile range, $1439-$2968]). There were no significant differences in other secondary outcomes between groups. Conclusions: In this multi-center randomized controlled study, HFNC compared to conventional oxygen therapy did not reduce need for intubation among acute COPD exacerbation patients with mild hypercapnia. The future studies should focus on patients with acute COPD exacerbation with respiratory acidosis (pH <7.35). However, because the primary outcome rate was well below expected, the study was underpowered to show a meaningful difference between the two treatment groups.
基金：
National Key Research and Development Program of China [2016YFC1304304, 2020YFC2003705]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81870072]; Non-profit Central Research Institute Fund of CAMS [2019TX320006]
第一作者机构：[1]China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, 2 East Yinghua Rd, Beijing 100029, Peoples R China[2]Natl Ctr Resp Med, Beijing, Peoples R China[3]Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China[4]Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China[5]Beihang Univ, Sch Biol Sci & Med Engn, Beijing, Peoples R China
共同第一作者：
通讯作者：
通讯机构：[1]China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, 2 East Yinghua Rd, Beijing 100029, Peoples R China[2]Natl Ctr Resp Med, Beijing, Peoples R China[3]Chinese Acad Med Sci, Inst Resp Med, Beijing, Peoples R China[4]Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China
推荐引用方式(GB/T 7714)：
Xia Jingen,Gu Sichao,Lei Wei,et al.High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial[J].CRITICAL CARE.2022,26(1):doi:10.1186/s13054-022-03973-7.
APA：
Xia, Jingen,Gu, Sichao,Lei, Wei,Zhang, Jihua,Wei, Hui...&Zhan, Qingyuan.(2022).High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial.CRITICAL CARE,26,(1)
MLA：
Xia, Jingen,et al."High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial".CRITICAL CARE 26..1(2022)
医学