High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease

BACKGROUND: The physiological effects of high-flow nasal cannula O(2) therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O(2) therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. METHODS: This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O(2) therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O(2) saturation target of 88–92%. Gas exchange, breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and work of breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTP(DI/min))) were recorded. RESULTS: EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O(2), and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O(2): p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTP(DI/min) increased from 135 ± 60 to 211 ± 70 cmH(2)O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O(2): p < 0.05 versus HFNC1 and HFNC2). CONCLUSIONS: In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and work of breathing compared with conventional O(2) therapy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2107-9) contains supplementary material, which is available to authorized users.