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The following is a summary of “High-flow nasal cannula may prolong the length of hospital stay in patients with hypercapnic acute COPD exacerbation,” published in the DECEMBER 2023 issue of Pulmonology by Xia, et al.

The use of high-flow nasal cannula (HFNC) in patients with acute exacerbation of COPD (AECOPD) is on the rise. For a study, researchers sought to determine whether baseline bicarbonate levels independently predict outcomes in hypercapnic AECOPD patients receiving HFNC.

The secondary analysis involved 330 patients with non-acidotic hypercapnic AECOPD enrolled in a multicenter randomized trial comparing HFNC to conventional oxygen treatment (COT). The length of hospital stay (LOS) and the rate of non-invasive positive pressure ventilation (NPPV) use were compared based on baseline bicarbonate levels, using statistical tests such as the log-rank test and the Cox proportional hazard model.

In the high bicarbonate subgroup (n = 165, bicarbonate 35.0[33.3–37.9] mmol/L, PaCO₂ 56.8[52.0–62.8] mmHg), patients on HFNC had a significantly prolonged LOS compared to those on COT (HR 1.59[1.16–2.17], P = 0.004). In the low bicarbonate subgroup (n = 165, bicarbonate 28.8[27.0–30.4] mmol/L, PaCO₂ 48.0[46.0–50.0] mmHg), LOS was similar regardless of respiratory support. The NPPV use rate in high bicarbonate patients was significantly higher than in low bicarbonate patients (19.4% vs. 3.0%, P < 0.0001). Among patients with high bicarbonate levels, the HFNC group had a lower NPPV use rate than the COT group (15.4% vs. 23.0%, P = 0.217).

In non-acidotic hypercapnic AECOPD patients with high baseline bicarbonate levels, HFNC is associated with a significantly prolonged hospital stay, potentially due to reduced escalation of NPPV treatment.

Source: resmedjournal.com/article/S0954-6111(23)00353-0/fulltext