Authors: Oguzhan Haciosman, Huseyin Ergenc, Adem Az, Yunus Dogan, Ozgur Sogut
Journal: American Journal of Emergency Medicine, 2024 October 28
Conclusion:
HFNC was not inferior to NIV for improving ABG parameters, including PaCO2, in patients with COPD exacerbations, especially those with hypercarbia. HFNC at a flow rate of 30 L/min was particularly effective, showing superior reduction in PaCO2 at 60 minutes compared to NIV, suggesting HFNC as a viable alternative in this patient population.
Methods:
In this prospective, randomized, single-blind trial, patients with acute COPD exacerbations were assigned to one of three groups:
- NIV group (n = 47), receiving bilevel positive airway pressure.
- HFNC-30 group (n = 44), receiving HFNC therapy at 30 L/min.
- HFNC-50 group (n = 46), receiving HFNC therapy at 50 L/min.
Demographic and clinical data, as well as arterial blood gas (ABG) parameters, were collected at baseline and at 30, 60, and 120 minutes post-treatment to compare the effectiveness of each treatment approach.
Results:
A total of 137 patients (90 males, 47 females) with a mean age of 68.1 ± 10.5 years were included. Of these, 21 patients (15.33%) required intubation, and the mortality rate was 10.2%. Baseline PaCO2 levels were similar across the groups (p = 0.372). All groups demonstrated a significant reduction in PaCO2 levels at each time point (30, 60, and 120 min; p < 0.05 for all). The reduction in PaCO2 at 60 minutes (ΔPaCO2) was significantly greater in the HFNC-30 group compared to the NIV group (p = 0.042). There were no significant differences in intubation rates or 28-day mortality among the groups (p = 0.368 and p = 0.775, respectively).