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Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial.
Res Nurs Health. 2019 06; 42(3):217-225.RN

Abstract

High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy. Forty-two COPD patients who had persistent hypercapnia at extubation were assigned randomly to receive HFNC (22) or NIV (20). Twenty patients in each group were enrolled for per-protocol analysis with regard to primary outcomes. Vital signs and ABGs before extubation were similar between groups. At 3 hr after extubation, pH in the NIV group was lower than HFNC group (7.42 ± 0.06 vs. 7.45 ± 0.05, p = 0.01). At 24 hr after extubation, patients' mean arterial pressure (82.97 ± 9.04 vs. 92.06 ± 11.11 mmHg, p = 0.05) and pH (7.42 ± 0.05 vs. 7.46 ± 0.03, p = 0.05) in the NIV group were lower than in the HFNC group. No significant differences were found at 48 hr after extubation. In the HFNC group, comfort scores were better (3.55 ± 2.01 vs. 5.15 ± 2.28, p = 0.02) and fewer patients needed bronchoscopy for secretion management within 48 hr after extubation (2/22 vs. 9/20, p = 0.03). HFNC is a potential alternative to NIV to wean hypercapnic COPD patients with regard to vital signs and ABGs, HFNC improved patients' comfort and secretion clearance.

Authors+Show Affiliations

Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30887549

Citation

Jing, Guoqiang, et al. "Comparison of High Flow Nasal Cannula With Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease Patients With Hypercapnia in Preventing Postextubation Respiratory Failure: a Pilot Randomized Controlled Trial." Research in Nursing & Health, vol. 42, no. 3, 2019, pp. 217-225.
Jing G, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial. Res Nurs Health. 2019;42(3):217-225.
Jing, G., Li, J., Hao, D., Wang, T., Sun, Y., Tian, H., Fu, Z., Zhang, Y., & Wang, X. (2019). Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial. Research in Nursing & Health, 42(3), 217-225. https://doi.org/10.1002/nur.21942
Jing G, et al. Comparison of High Flow Nasal Cannula With Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease Patients With Hypercapnia in Preventing Postextubation Respiratory Failure: a Pilot Randomized Controlled Trial. Res Nurs Health. 2019;42(3):217-225. PubMed PMID: 30887549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial. AU - Jing,Guoqiang, AU - Li,Jie, AU - Hao,Dong, AU - Wang,Tao, AU - Sun,Yunliang, AU - Tian,Huanhuan, AU - Fu,Zhong, AU - Zhang,Yuewei, AU - Wang,Xiaozhi, Y1 - 2019/03/18/ PY - 2018/10/30/received PY - 2019/01/11/revised PY - 2019/02/22/accepted PY - 2019/3/20/pubmed PY - 2019/6/14/medline PY - 2019/3/20/entrez KW - chronic obstructive pulmonary disease KW - high flow nasal cannula KW - hypercapnia KW - noninvasive ventilation SP - 217 EP - 225 JF - Research in nursing & health JO - Res Nurs Health VL - 42 IS - 3 N2 - High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy. Forty-two COPD patients who had persistent hypercapnia at extubation were assigned randomly to receive HFNC (22) or NIV (20). Twenty patients in each group were enrolled for per-protocol analysis with regard to primary outcomes. Vital signs and ABGs before extubation were similar between groups. At 3 hr after extubation, pH in the NIV group was lower than HFNC group (7.42 ± 0.06 vs. 7.45 ± 0.05, p = 0.01). At 24 hr after extubation, patients' mean arterial pressure (82.97 ± 9.04 vs. 92.06 ± 11.11 mmHg, p = 0.05) and pH (7.42 ± 0.05 vs. 7.46 ± 0.03, p = 0.05) in the NIV group were lower than in the HFNC group. No significant differences were found at 48 hr after extubation. In the HFNC group, comfort scores were better (3.55 ± 2.01 vs. 5.15 ± 2.28, p = 0.02) and fewer patients needed bronchoscopy for secretion management within 48 hr after extubation (2/22 vs. 9/20, p = 0.03). HFNC is a potential alternative to NIV to wean hypercapnic COPD patients with regard to vital signs and ABGs, HFNC improved patients' comfort and secretion clearance. SN - 1098-240X UR - https://www.unboundmedicine.com/medline/citation/30887549/Comparison_of_high_flow_nasal_cannula_with_noninvasive_ventilation_in_chronic_obstructive_pulmonary_disease_patients_with_hypercapnia_in_preventing_postextubation_respiratory_failure:_A_pilot_randomized_controlled_trial_ L2 - https://doi.org/10.1002/nur.21942 DB - PRIME DP - Unbound Medicine ER -