Efficacy and safety of nasal high-flow humidified oxygen therapy and non-invasive positive pressure ventilation in patients with acute exacerbation of COPD complicated with respiratory failure

Objective To compare the clinical efficacy and safety of high-flow nasal cannula （HFNC） and non-invasive positive pressure ventilation （NPPV） with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with chronic respiratory failure. Methods A total of 68 AECOPD patients were recruited and randomly assigned into the HFNC （n = 34） and NPPV groups （n = 34）. On the basis of comprehensive treatment, nasal high-flow humidified oxygen therapy was delivered in the HFNC group, and non-invasive positive pressure ventilation was given in the NPPV group. Blodd gas analysis and sputum viscosity were assessed before and after corresponding interventions. The changes of PaO₂, PaCO₂ and sputum viscosity were analyzed. The incidence of adverse reactions, such as abdominal distention and facial compression, were observed during the treatment. After interventions, the subjective comfort level of the auxiliary ventilation was scored by the patients. All these parameters were statistically compared between the HENC and NPPV groups. Results Before treatment, the PaO₂, PaCO₂ and sputum viscosity did not significantly differ between the HFNC and NPPV groups （all P > 0.05）. After interventions, the three parameters were significantly improved in both groups （all P < 0.05）. The PaCO₂ and sputum viscosity in the HFNC group were considerably lower compared with those in the NPPV group （both P < 0.05）. During treatment, abdominal distension occurred in 7 cases （21%） in the NPPV group, whereas none （0%） in the HFNC group （P < 0.05）. Facial compression was observed in 1 patient （3%） in the HFNC group, significantly lower than 9 cases （26%） in the NPPV group （P < 0.05）. In addition, the total score in comfort level and the sub-scores in physiological, psychological and environmental dimensions in the HFNC group were significantly higher than those in the NPPV group （all P < 0.05）. Conclusion Compared with NPPV, HFNC can significantly dilute the sputum viscosity, improve the hypoxia, and reduce the risk of adverse reactions in the treatment of AECOPD patients complicated with respiratory failure.