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European Journal of Medical Research
Published in: European Journal of Medical Research 1/2021

Open Access 01-12-2021 | Chronic Obstructive Lung Disease | Research

The efficacy and safety of high-flow nasal cannula therapy in patients with COPD and type II respiratory failure: a meta-analysis and systematic review

Authors: Zhiping Xu, Lingxia Zhu, Jingye Zhan, Lijun Liu

Published in: European Journal of Medical Research | Issue 1/2021

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Abstract

Background

High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have been used for the treatment of COPD and respiratory failure in clinical settings. We aimed to evaluate the efficacy and safety of HFNC therapy in patients with COPD and type II respiratory failure, to provide evidence to the clinical COPD management.

Methods

We searched Cochrane et al. databases up to Dec 31, 2020 for randomized controlled trials (RCTs) on the use of HFNC therapy in patients with COPD and type II respiratory failure. Two researchers independently screened the literature according to the inclusion and exclusion criteria, and evaluated the quality of the literature and extracted data. We used Revman5.3 software for statistical analysis of collected data.

Results

A total of 6 RCTs involving 525 COPD and type II respiratory failure patients. Meta-analyses indicated that compared with NIV, HFNC could significantly reduce PaCO2 level (MD = − 2.64, 95% CI (− 3.12 to − 2.15)), length of hospital stay ((MD = – 1.19, 95 CI (− 2.23 to − 0.05)), the incidence of nasal facial skin breakdown ((OR = 0.11, 95% CI (0.03–0.41)). And there were no significant differences between the two groups in PaO2 ((MD = 2.92, 95% CI (− 0.05 to 5.90)), incidence of tracheal intubation ((OR = 0.74, 95% CI (0.34–1.59)) and mortality (OR = 0.77, 95% CI (0.28–2.11)).

Conclusions

HFNC is more advantageous over NIV in the treatment of COPD and type II respiratory failure. Future studies with larger sample size and strict design are needed to further elucidate the role of HFNC in COPD and respiratory failure.
Literature
1.
Labaki WW, Rosenberg SR. Chronic obstructive pulmonary disease. Ann Intern Med. 2020;173(3):ITC17–32.PubMedCrossRef
2.
3.
Gredic M, Blanco I, Kovacs G, Helyes Z, Ferdinandy P, Olschewski H, Barbera JA, Weissmann N. Pulmonary hypertension in chronic obstructive pulmonary disease. Br J Pharmacol. 2021;178(1):132–51.PubMedCrossRef
4.
Duffy SP, Criner GJ. Chronic obstructive pulmonary disease: evaluation and management. Med Clin North Am. 2019;103(3):453–61.PubMedCrossRef
5.
Hattab Y, Alhassan S, Balaan M, Lega M, Singh AC. Chronic obstructive pulmonary disease. Crit Care Nurs Q. 2016;39(2):124–30.PubMedCrossRef
6.
Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF. Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD science committee report on COVID-19 and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2021;203(1):24–36.PubMedPubMedCentralCrossRef
7.
Hanson C, Bowser EK, Frankenfield DC, Piemonte TA. Chronic obstructive pulmonary disease: a 2019 evidence analysis center evidence-based practice guideline. J Acad Nutr Diet. 2021;121(1):139-165e115.PubMedCrossRef
8.
Dicker AJ, Huang JTJ, Lonergan M, Keir HR, Fong CJ, Tan B, Cassidy AJ, Finch S, Mullerova H, Miller BE, et al. The sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2021;147(1):158–67.PubMedCrossRef
9.
Xu S, Ye Z, Ma J, Yuan T. The impact of chronic obstructive pulmonary disease on hospitalization and mortality in patients with heart failure. Eur J Clin Invest. 2021;51(1):e13402.PubMedCrossRef
10.
Hong H, Li XX, Li J, Zhang ZQ. High-flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in preterm infants: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2021;34(2):259–66.PubMedCrossRef
11.
Suffredini DA, Allison MG. A rationale for use of high flow nasal cannula for select patients with suspected or confirmed severe acute respiratory syndrome coronavirus-2 infection. J Intensive Care Med. 2021;36(1):9–17.PubMedCrossRef
12.
Shah S, Kaul A, Bhosale R, Shiwarkar G. High flow nasal cannula therapy as a primary mode of respiratory support in a pediatric intensive care unit. Indian Pediatr. 2021;58(1):41–3.PubMedCrossRef
13.
14.
Pisani L, Astuto M, Prediletto I, Longhini F. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology. 2019;25(6):348–54.PubMedCrossRef
15.
16.
Criner G. Sorting out the mechanisms of benefit of high flow nasal cannula in stable COPD. Chronic Obstr Pulm Dis. 2017;4(4):259–61.PubMedPubMedCentral
17.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.PubMedPubMedCentralCrossRef
18.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:5928.CrossRef
19.
Jianjun W, Hongying J, Qing L. A randomized controlled study of transnasal high-flow humidification oxygen therapy and non-invasive positive pressure ventilation in the treatment of acute exacerbations of chronic obstructive pulmonary disease with type II respiratory failure. Chinese Emerg Med. 2019;39(10):945–8.
20.
Liu J. Comparison of nasal high-flow oxygen therapy and non-invasive ventilation in chronic obstructive pulmonary disease with respiratory failure. Hebei Medical University; 2018.
21.
Liu P, Chuanming G, Lei Q. Comparison of high flow oxygen therapy and non-invasive positive pressure ventilation in the treatment of COPD with respiratory failure. Med J Nat Defend Forces Southwest China. 2018;28(12):1168–70.
22.
Liyuan G, Chaohong L, Tiantian W. Clinical study of nasal high-flow oxygen therapy in the treatment of chronic obstructive pulmonary disease in acute exacerbation stage with type II respiratory failure. J Clin Pulmonary Med. 2018;23(7):1337–40.
23.
Long C, Dansi Z, Danzhou L. The effect of nasal high-flow humidification oxygen therapy on blood gas analysis indexes and mean arterial pressure in patients with chronic obstructive pulmonary disease and type II respiratory failure. J Clin Exp Med. 2020;19(21):59–63.
24.
Xin J. Nasal high-flow oxygen therapy and non-invasive positive pressure ventilation in elderly patients with AECOPD comparative study in early intervention. Hangzhou Zhejiang University of Traditional Chinese Medicine; 2019.
25.
Nguyen JMK, Robinson DN, Sidhaye VK. Why new biology must be uncovered to advance therapeutic strategies for chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol. 2021;320(1):L1–11.PubMedCrossRef
26.
Deshmukh K, Khanna A. Implications of managing chronic obstructive pulmonary disease in cardiovascular diseases. Tuberc Respir Dis (Seoul). 2021;84(1):35–45.CrossRef
27.
Ji R, He Q, Zhang R, Gao Z, Ding D. A genetic study of the depressive respiratory responses to hypoxia in chronic obstructive pulmonary disease patients with type II respiratory failure. Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2000;17(3):173–7.PubMed
28.
Zhang MC, Wang ZG, Cheng JX, Wang JL, Zheng SP. The study on the value of using the chronic obstructive pulmonary disease and asthma physiology score to assess the severity of acute exacerbation in patients with chronic obstructive pulmonary disease complicated by type II respiratory failure. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2010;22(5):275–8.PubMed
29.
Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth interventions to support self-management of long-term conditions: a systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. J Med Internet Res. 2017;19(5):e172.PubMedPubMedCentralCrossRef
30.
Savi A, Gasparetto Maccari J, Frederico Tonietto T, Pecanha Antonio AC, Pinheiro de Oliveira R, de Mello Rieder M, Zignani EC, Boschi da Silva E, Teixeira C. Influence of FIO2 on PaCO2 during noninvasive ventilation in patients with COPD. Respir Care. 2014;59(3):383–7.PubMedCrossRef
31.
Yang PL, Yu JQ, Chen HB. High-flow nasal cannula for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. Heart Lung. 2021;50(2):252–61.PubMedCrossRef
32.
Huang X, Du Y, Ma Z, Zhang H, Jun L, Wang Z, Lin M, Ni F, Li X, Tan H, et al. High-flow nasal cannula oxygen versus conventional oxygen for hypercapnic chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Clin Respir J. 2021;15(4):437–44.PubMedCrossRef
33.
Jens B, Dominic D, Andres B. Nasal high- flow versus noninvasive ventilation in patients with chronic hypercapnic COPD. Int J Chron Obstruct Pulmon Dis. 2019;18(12):1411–21.
34.
Storgaard LH, Hockey HU, Laursen BS, Weinreich UM. Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron Obstruct Pulmon Dis. 2018;13:1195–205.PubMedPubMedCentralCrossRef
35.
Hernandez G, Vaquero C, Colinas L, Cuena R, Gonzalez P, Canabal A, Sanchez S, Rodriguez ML, Villasclaras A, Fernandez R. Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA. 2016;316(15):1565–74.PubMedCrossRef
36.
Cortegiani A, Longhini F, Carlucci A, Scala R, Groff P, Bruni A, Garofalo E, Taliani MR, Maccari U, Vetrugno L, et al. High-flow nasal therapy versus noninvasive ventilation in COPD patients with mild-to-moderate hypercapnic acute respiratory failure: study protocol for a noninferiority randomized clinical trial. Trials. 2019;20(1):450.PubMedPubMedCentralCrossRef
37.
Li J, Jing G, Scott JB. Year in review 2019: high-flow nasal cannula oxygen therapy for adult subjects. Respir Care. 2020;65(4):545–57.PubMedCrossRef
38.
Pisani L, Betti S, Biglia C, Fasano L, Catalanotti V, Prediletto I, Comellini V, Bacchi-Reggiani L, Fers SN. Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study. BMC Pulm Med. 2020;20(1):12.PubMedPubMedCentralCrossRef
39.
Sun J, Li Y, Ling B, Zhu Q, Hu Y, Tan D, Geng P, Xu J. 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. Int J Chron Obstruct Pulmon Dis. 2019;14:1229–37.PubMedPubMedCentralCrossRef
40.
Bruni A, Garofalo E, Cammarota G, Murabito P, Astuto M, Navalesi P, Luzza F, Abenavoli L, Longhini F. High flow through nasal cannula in stable and exacerbated chronic obstructive pulmonary disease patients. Rev Recent Clin Trials. 2019;14(4):247–60.PubMedCrossRef
41.
Di Mussi R, Spadaro S, Stripoli T, Volta CA, Trerotoli P, Pierucci P, Staffieri F, Bruno F, Camporota L, Grasso S. High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease. Crit Care. 2018;22(1):180.PubMedCrossRef
42.
Nagata K, Kikuchi T, Horie T, Shiraki A, Kitajima T, Kadowaki T, Tokioka F, Chohnabayashi N, Watanabe A, Sato S, et al. Domiciliary high-flow nasal cannula oxygen therapy for patients with stable hypercapnic chronic obstructive pulmonary disease. A multicenter randomized crossover trial. Ann Am Thorac Soc. 2018;15(4):432–9.PubMedCrossRef
43.
Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148(1):253–61.PubMedCrossRef
44.
Spicuzza L, Schisano M. High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future. Ther Adv Chronic Dis. 2020;11:2040622320920106.PubMedPubMedCentralCrossRef
45.
Vogelsinger H, Halank M, Braun S, Wilkens H, Geiser T, Ott S, Stucki A, Kaehler CM. Efficacy and safety of nasal high-flow oxygen in COPD patients. BMC Pulm Med. 2017;17(1):143.PubMedPubMedCentralCrossRef
46.
Rittayamai N, Phuangchoei P, Tscheikuna J, Praphruetkit N, Brochard L. Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study. Ann Intensive Care. 2019;9(1):122.PubMedPubMedCentralCrossRef
47.
Tan D, Walline JH, Ling B, Xu Y, Sun J, Wang B, Shan X, Wang Y, Cao P, Zhu Q, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Crit Care. 2020;24(1):489.PubMedPubMedCentralCrossRef
48.
Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child. 2019;104(6):564–76.PubMedCrossRef
49.
Luo J, Duke T, Chisti MJ, Kepreotes E, Kalinowski V, Li J. Efficacy of high-flow nasal cannula vs standard oxygen therapy or nasal continuous positive airway pressure in children with respiratory distress: a meta-analysis. J Pediatr. 2019;215:199-208e198.PubMedCrossRef
50.
Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev. 2014;3:CD009850.
51.
Sinha IP, McBride AKS, Smith R, Fernandes RM. CPAP and high-flow nasal cannula oxygen in bronchiolitis. Chest. 2015;148(3):810–23.PubMedCrossRef
Metadata
Title
The efficacy and safety of high-flow nasal cannula therapy in patients with COPD and type II respiratory failure: a meta-analysis and systematic review
Authors
Zhiping Xu
Lingxia Zhu
Jingye Zhan
Lijun Liu
Publication date
01-12-2021
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2021
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-021-00587-7

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