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首页> 外文期刊>BMC Pulmonary Medicine >Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study
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Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study

机译：高流量鼻腔插管在急性COPD加剧后持续的高凝血症患者：预期试验研究

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Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed the acceptability of HFNC and its effectiveness in reducing the level of PaCO2 in patients recovering from an Acute Hypercapnic Respiratory Failure (AHRF) episode. We also hypothesized that the response in CO2 clearance is dependent on baseline level of hypercapnia. Fifty COPD patients recovering from an acute exacerbation and with persistent hypercapnia, despite having attained a stable pH (i.e. pH??7,35 and PaCO2??45?mmHg on 3 consecutive measurements), were enrolled and treated with HFNC for at least 8?h/day and during the nighttime HFNC was well tolerated with a global tolerance score of 4.0?±?0.9. When patients were separated into groups with or without COPD/OSA overlap syndrome, the “pure” COPD patients showed a statistically significant response in terms of PaCO2 decrease (p?=?0.044). In addition, the subset of patients with a lower pH at enrolment were those who responded best in terms of CO2 clearance (score test for trend of odds, p?=?0.0038). HFNC is able to significantly decrease the level of PaCO2 after 72?h only in “pure” COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV. This study is registered with www. clinicaltrials.gov with identifier number NCT03759457.
机译：COPD加剧后持续的Hy​​percapnia与过量的死亡率和早期再回合中有关。高流量鼻腔插管（HFNC），理论上可能是长期非侵入性通气（NIV）的替代物，因为生理学研究在几个小时后显示了PACO2水平的降低。在该临床研究中，我们评估了HFNC的可接受性及其在从急性高急性呼吸衰竭（AHRF）发作中恢复的患者中PACO2水平的可接受性。我们还假设二氧化碳清关的反应依赖于高碳膜炎的基线水平。尽管达到了稳定的pH（即pH？>β7,35和PACO2，但在3个连续测量中达到急性加剧和持续的Hy​​percapnia，但仍然持续持续的Hy​​cApnnia，持续活跃的患者的患者从急性加剧和持续的Hy​​percapnia恢复至少8？H / Day，夜间HFNC在全球公差得分为4.0？±0.9的情况下耐受良好耐受。当患者分离成有或没有COPD / OSA重叠综合征的组，“纯”COPD患者在PACO2减少方面表现出统计学上的反应（P？= 0.044）。此外，在入学时患者较低的患者的患者是在二氧化碳清关（G计量趋势的评分测试）中最佳的患者，P？= 0.0038）。 HFNC能够在72℃下显着降低PACO2的水平，仅在“纯”COPD患者中，从AHRF恢复。在具有重叠综合征的人中发现了在CO2还原方面没有效果。本研究结果将有助于指导最佳目标种群的选择，并允许HFNC与NIV的未来长期随机控制试验进行样本量计算。本研究与WWW一起注册。 ClinicalTrials.gov标识符Node NCT03759457。

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