Efficacy of High Flow Nasal Cannula Vs Non Invasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease-A Randomized Control Study

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease characterized by various symptoms with a significant impact on morbidity and mortality. Non-Invasive Ventilation Bilevel Positive Airway Pressure (NIV BIPAP) is the gold standard modality of treatment in patients with acute exacerbation of COPD with hypercapnic respiratory failure. High Flow Nasal Cannula is a newer modality and its role in AECOPD with hypercapnic respiratory failure is debatable. As there is little evidence comparing the NIV BIPAP and HFNC, this study aims to find the efficacy of HFNC over BIPAP in AECOPD with hypercapnic respiratory failure.

Objectives: To compare the efficacy of High Flow Nasal Cannula with Non-Invasive Ventilation Bilevel Positive Airway Pressure as an initial modality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease by clinical parameters and Arterial Blood Gas analysis.

Methods: This randomized control study was conducted at the Department of Respiratory Medicine, SMVMCH, Puducherry, from September 2022 to March 2024. The participants were assigned to NIV BIPAP or HFNC groups by block randomization. They were assessed in terms of MMRC grade of breathlessness, Respiratory Rate, Pulse Rate, SpO2 and ABG parameters like pH, pO2, pCO2 at baseline,  2 hours and 6 hours respectively.
Results: There was a significant reduction in grades of breathlessness, respiratory rate, pulse rate and PCO2 levels in both the HFNC and the NIV BIPAP group compared to the baseline. There was a significant rise in SpO2 and pH levels compared to baseline in both the groups. There was a significant rise in PO2 levels from baseline to 6 hours  in NIV BIPAP group which was not there in the HFNC group.

Conclusion: As the efficacy of HFNC is similar to that of NIV BIPAP in the improvement of clinical and ABG values, HFNC can be considered as a non inferior modality compared to NIV BIPAP in acute exacerbation of COPD.