Comparison of high-flow oxygenation with noninvasive ventilation in COPD exacerbation: A crossover clinical trial

To compare the therapeutic effects of high-flow-oxygen-Therapy (HFT) and noninvasive-ventilation (NIV) for stabilizing chronic obstructive pulmonary disease during exacerbation.

In this randomized clinical trial at Masih-Daneshvari hospital, between July 2019 and Oct 2019, 30 exacerbated-COPD-patient with PaCO₂ 64.58 ± 11.61 mm Hg, Respiratory Rate 24.43 ± 2.75, and PH 7.31 ± 0.02 were divided into two groups, N = 15. By a simple randomized allocation, patients receive either NIV or HFT for 1 hour, and following a washout period of 30 minutes, they switched to the other treatment option. Arterial Blood Gas Parameters, as well as Respiratory Rate (RR), Dyspnea Score, Heart Rate (HR), and Oxygen Saturation (SO₂ ), were compared before and after the intervention and between groups.

Baseline patient characteristics were similar in the two groups. Pre and post-analysis revealed that in both groups, all improved significantly. After the first period, there was no difference in all parameters between groups except for SO₂ which was significantly higher in HFT (%92.1 ± 1) than that of NIV (%89 ± 1), P = .001. Likewise, following the washout period, patients in HFT and NIV had a dyspnea score of 1.93 ± 0.7 and 2.73 ± 0.9, respectively, P = .01. No carryover-effect and was observed but the period effect was significant for some outcomes. A significant improvement in SO₂ and HR was observed by HFT according to treatment effect by combining two periods' results. During the study, no side effects were reported.

In this short-term study HFT appears feasible for patients with COPD exacerbation to reduce dyspnea score and improve respiratory distress.