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Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial
INTRODUCTION: Persistent hypercapnic failure in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. Long-term home non-invasive ventilation is recommended for patients with PaCO(2) >7.0 kPa. Domiciliary high-flow nasal cannula (HFNC) reduces PaCO(2) in short-term studi...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677330/ https://www.ncbi.nlm.nih.gov/pubmed/33208303 http://dx.doi.org/10.1136/bmjresp-2020-000712 |
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author | Storgaard, Line Hust Hockey, Hans-Ulrich Weinreich, Ulla Møller |
author_facet | Storgaard, Line Hust Hockey, Hans-Ulrich Weinreich, Ulla Møller |
author_sort | Storgaard, Line Hust |
collection | PubMed |
description | INTRODUCTION: Persistent hypercapnic failure in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. Long-term home non-invasive ventilation is recommended for patients with PaCO(2) >7.0 kPa. Domiciliary high-flow nasal cannula (HFNC) reduces PaCO(2) in short-term studies. This post-hoc analysis examines the effect of HFNC on PaCO(2) levels, exacerbations and admissions in patients with COPD with persistent hypercapnic and hypoxic failures. METHODS: The original trial included 74 long-term oxygen-treated patients (31 HFNC treated/43 controls) with persistent hypercapnic failure (PaCO(2) >6 kPa) who completed the 12-month study period. Baseline data included age, sex, blood gases, exacerbations and hospital admissions in the previous year. Data on blood gases were also recorded at 6 and 12 months for all patients. In addition, acute changes in blood gases after 30 min of HFNC use at site visits were examined, as were exacerbations and hospital admissions during study. RESULTS: Patients were comparable at baseline. After 12 months there was a 1.3% decrease in PaCO(2) in patients using HFNC and a 7% increase in controls before HFNC use on site (p=0.003). After 30 min of HFNC at visits PaCO(2) changed significantly, with comparable reductions, at 0, 6 and 12 months, including for controls who tried HFNC at study end (p<0.001). The exacerbation rate increased, compared with 12 months prestudy, by 2.2/year for controls (p<0.001) and 0.15/year for HFNC-treated patients (p=0.661). Hospital admission rates increased in the control group,+0.3/year from prestudy (p=0.180), And decreased by 0.67/year (p=0.013)for HFNC-treated patients. CONCLUSION: This post-hoc analysis indicates that HFNC stabilises patients with COPD with persistent hypoxic and hypercapnic failures, in terms of PaCO(2), exacerbations and number of hospitalisations, whereas those not receiving HFNC worsened. This suggests that HFNC is a possible treatment for patients with persistent hypercapnic COPD. |
format | Online Article Text |
id | pubmed-7677330 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-76773302020-11-30 Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial Storgaard, Line Hust Hockey, Hans-Ulrich Weinreich, Ulla Møller BMJ Open Respir Res Chronic Obstructive Pulmonary Disease INTRODUCTION: Persistent hypercapnic failure in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. Long-term home non-invasive ventilation is recommended for patients with PaCO(2) >7.0 kPa. Domiciliary high-flow nasal cannula (HFNC) reduces PaCO(2) in short-term studies. This post-hoc analysis examines the effect of HFNC on PaCO(2) levels, exacerbations and admissions in patients with COPD with persistent hypercapnic and hypoxic failures. METHODS: The original trial included 74 long-term oxygen-treated patients (31 HFNC treated/43 controls) with persistent hypercapnic failure (PaCO(2) >6 kPa) who completed the 12-month study period. Baseline data included age, sex, blood gases, exacerbations and hospital admissions in the previous year. Data on blood gases were also recorded at 6 and 12 months for all patients. In addition, acute changes in blood gases after 30 min of HFNC use at site visits were examined, as were exacerbations and hospital admissions during study. RESULTS: Patients were comparable at baseline. After 12 months there was a 1.3% decrease in PaCO(2) in patients using HFNC and a 7% increase in controls before HFNC use on site (p=0.003). After 30 min of HFNC at visits PaCO(2) changed significantly, with comparable reductions, at 0, 6 and 12 months, including for controls who tried HFNC at study end (p<0.001). The exacerbation rate increased, compared with 12 months prestudy, by 2.2/year for controls (p<0.001) and 0.15/year for HFNC-treated patients (p=0.661). Hospital admission rates increased in the control group,+0.3/year from prestudy (p=0.180), And decreased by 0.67/year (p=0.013)for HFNC-treated patients. CONCLUSION: This post-hoc analysis indicates that HFNC stabilises patients with COPD with persistent hypoxic and hypercapnic failures, in terms of PaCO(2), exacerbations and number of hospitalisations, whereas those not receiving HFNC worsened. This suggests that HFNC is a possible treatment for patients with persistent hypercapnic COPD. BMJ Publishing Group 2020-11-18 /pmc/articles/PMC7677330/ /pubmed/33208303 http://dx.doi.org/10.1136/bmjresp-2020-000712 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Chronic Obstructive Pulmonary Disease Storgaard, Line Hust Hockey, Hans-Ulrich Weinreich, Ulla Møller Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
title | Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
title_full | Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
title_fullStr | Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
title_full_unstemmed | Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
title_short | Development in PaCO(2) over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
title_sort | development in paco(2) over 12 months in patients with copd with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial |
topic | Chronic Obstructive Pulmonary Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677330/ https://www.ncbi.nlm.nih.gov/pubmed/33208303 http://dx.doi.org/10.1136/bmjresp-2020-000712 |
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