International Journal of COPD (May 2023)
Comparison of High-Flow Nasal Cannula with Conventional Oxygen Therapy in Patients with Hypercapnic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
Abstract
Lisha Zhang,1,* Yuxiu Wang,2,* Yaokun Ye,2 JunYin Gao,2 Fabei Zhu,1 Lingfeng Min2 1Department of Respiratory and Critical Care Medicine, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou City, Jiangsu Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Clinical Medical College, Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lingfeng Min, Department of Respiratory and Critical Care Medicine, Clinical Medical College, Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China, Tel +86 19962595724, Email [email protected]: This study aimed to evaluate the clinical outcomes of high-flow nasal cannula (HFNC) compared with conventional oxygen therapy (COT) in patients with hypercapnic chronic obstructive pulmonary disease (COPD), including arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), respiratory rate (RR), treatment failure, exacerbation rates, adverse events and comfort evaluation.Patients and Methods: PubMed, EMBASE and the Cochrane Library were retrieved from inception to September 30, 2022. Eligible trials were randomized controlled trials and crossover studies comparing HFNC and COT in hypercapnic COPD patients. Continuous variables were reported as mean and standard derivation and calculated by weighted mean differences (MD), while dichotomous variables were shown as frequency and proportion and calculated by odds ratio (OR), with the 95% confidence intervals (Cl). Statistical analysis was performed using RevMan 5.4 software.Results: Eight studies were included, five with acute hypercapnia and three with chronic hypercapnia. In acute hypercapnic COPD, short-term HFNC reduced PaCO2 (MD − 1.55, 95% CI: − 2.85 to − 0.25, I² = 0%, p < 0.05) and treatment failure (OR 0.54, 95% CI: 0.33 to 0.88, I² = 0%, p< 0.05), but there were no significant differences in PaO2 (MD − 0.36, 95% CI: − 2.23 to 1.52, I² = 45%, p=0.71) and RR (MD − 1.07, 95% CI: − 2.44 to 0.29, I² = 72%, p=0.12). In chronic hypercapnic COPD, HFNC may reduce COPD exacerbation rates, but there was no advantage in improving PaCO2 (MD − 1.21, 95% CI: − 3.81 to 1.39, I² = 0%, p=0.36) and PaO2 (MD 2.81, 95% CI: − 1.39 to 7.02, I² = 0%, p=0.19).Conclusion: Compared with COT, short-term HFNC reduced PaCO2 and the need for escalating respiratory support in acute hypercapnic COPD, whereas long-term HFNC reduced COPD exacerbations rates in chronic hypercapnia. HFNC has great potential for treating hypercapnic COPD.Keywords: nasal high-flow oxygen therapy, conventional oxygen therapy, hypercapnia, chronic obstructive pulmonary disease, meta-analysis
