What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

Effects of high-flow nasal cannula oxygen therapy for patients with acute exacerbation of chronic obstructive pulmonary disease in combination with type II respiratory failure

OBJECTIVE

To evaluate the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure.

METHODS

Seventy-two patients with AECOPD and type II respiratory failure were randomly allocated to an HFNC oxygen therapy trial group or a non-invasive positive-pressure ventilator therapy (NIPPV) control group. Their arterial blood gas parameters and comfort, evaluated using a questionnaire, were compared before and after the therapeutic interventions.

RESULTS

The PaCO₂ and blood HCO3- concentration of both groups were significantly reduced by the treatments, whereas the pH, PaO₂ and PaO₂/FiO₂ were increased. The PaCO₂ of the experimental group was significantly lower than that of the control group following treatment. The PaO₂ of the experimental group was significantly higher than that of the control group. The tracheal intubation rates of the two groups did not significantly differ. After treatment, all the indices of comfort were rated higher in the HFNC group than in the NIPPV group.

CONCLUSIONS

HFNC has a good therapeutic effect in patients with AECOPD and type II respiratory failure. It improves patient comfort and has clinical value.

Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis

Objective

To compare the safety and efficacy of transnasal high-flow oxygen therapy (HFNT) and noninvasive positive pressure ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with type II respiratory failure.

Methods

PubMed, the Cochrane Library, Embase, CBM, CNKI, and other databases were searched for randomized controlled trials (RCTS) on the efficacy of HFNT and NIV in the treatment of COPD. Meta-analysis was conducted using RevMan 5.3 software after two researchers screened literatures, extracted data, and evaluated the methodological quality of the included studies according to inclusion and exclusion criteria.

Results

A total of 948 patients were included in 12 RCTS. Comprehensive analysis results showed that the HFNC group had higher levels of 12 h-PAO2, 48 h-PACO2 and, 48 h-pH than the NIV group, and the differences were statistically significant (P < 0.05). There were no significant differences in 24 h-PAO2 and 72 h-PAO2, 12 h-PACO2, 24 h-PACO2 and 72 h-PACO2, 24 h-pH, 48 h-pH, and 72 h-pH between the two groups after treatment (P > 0.05).

Conclusions

Compared with NIV, HFNC does not increase the treatment failure rate in COPD patients with type II respiratory failure, and HFNC has better comfort and tolerance, which is a new potential respiratory support treatment for COPD patients with type II respiratory failure.

Long non-coding RNA NEAT1 predicts elevated chronic obstructive pulmonary disease (COPD) susceptibility and acute exacerbation risk, and correlates with higher disease severity, inflammation, and lower miR-193a in COPD patients

This study aimed to explore the value of long non-coding RNA nuclear enriched abundant transcript 1 (lnc-NEAT1) in predicting chronic obstructive pulmonary disease (COPD) susceptibility and acute exacerbation risk, and to investigate the correlation of lnc-NEAT1 with disease severity, inflammation level, and miR-193a in COPD patients. 90 AECOPD patients, 90 stable COPD patients and 90 healthy controls were consecutively recruited. Severity of airflow obstruction in COPD patients was defined by GOLD guidelines. Plasma samples were collected from all participants, then lnc-NEAT1 and miR-193a expressions were measured by qPCR, and TNF-α, IL-1β, IL-6, and IL-17 were measured by ELISA. Lnc-NEAT1 expression was elevated in AECOPD patients and stable COPD patients compared to healthy controls, as well as in AECOPD patients compared to stable COPD patients; moreover, ROC curves showed that lnc-NEAT1 predicted increased COPD susceptibility and acute exacerbation risk of COPD. Also, lnc-NEAT1 expression positively correlated with GOLD stage and levels of TNF-α, IL-1β, IL-6 and IL-17 in both AECOPD and stable COPD patients. Furthermore, lnc-NEAT1 expression negatively correlated with miR-193a expression, and miR-193a could predict decreased COPD susceptibility and acute exacerbation risk, and negatively correlated with GOLD stage and levels of TNF-α, IL-1β, IL-6 and IL-17 in both AECOPD and stable COPD patients. lnc-NEAT1 predicts elevated COPD susceptibility and increased acute exacerbation risk, and positively correlates with disease severity as well as inflammation, but negatively associates with miR-193a in COPD patients.

High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: an observational cohort study

Background

High-flow nasal cannula (HFNC) oxygen therapy in acute hypoxic respiratory failure is becoming increasingly popular. However, evidence to support the use of HFNC in acute respiratory failure (ARF) with hypercapnia is limited.

Methods

Chronic obstructive pulmonary disease (COPD) patients with moderate hypercapnic ARF (arterial blood gas pH 7.25–7.35, PaCO₂>50 mmHg) who received HFNC or non-invasive ventilation (NIV) in the intensive care uint from April 2016 to March 2018 were analyzed retrospectively. The endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa), and 28-day mortality.

Results

Eighty-two COPD patients (39 in the HFNC group and 43 in the NIV group) were enrolled in this study. The mean age was 71.8±8.2 and 54 patients (65.9%) were male. The treatment failed in 11 out of 39 patients with HFNC (28.2%) and in 17 of 43 patients with NIV (39.5%) (P=0.268). No significant differences were found for 28-day mortality (15.4% in the HFNC group and 14% in the NIV group, P=0.824). During the first 24 hrs of treatment, the number of nursing airway care interventions in the HFNC group was significantly less than in the NIV group, while the duration of device application was significantly longer in the HFNC group (all P<0.05). Skin breakdown was significantly more common in the NIV group (20.9% vs 5.1%, P<0.05).

Conclusion

Among COPD patients with moderate hypercarbic ARF, the use of HFNC compared with NIV did not result in increased rates of treatment failure, while there were fewer nursing interventions and skin breakdown episodes reported in the HFNC group.