Scripties UMCG - Rijksuniversiteit Groningen
 
English | Nederlands

A feasibility study of nasal high flow therapy in patients presenting with an acute exacerbation of chronic obstructivepulmonary disease with acute hypercapnic respiratory failure.

(2017) Baarsma, J.P. (Jan Pieter)

COPD represents a major public health challenge worldwide. About 20% of people
presenting with an acute exacerbation of COPD (AECOPD) will develop acute hypercapnic
respiratory failure (AHRF). Currently, after a 60-minute optimisation period, non-invasive
ventilation is often required to assist with a patient’s ventilation. This feasibility study
collected data to seek answers for the feasibility issues which are needed to accurately plan a
large randomised controlled trial comparing nasal high-flow therapy to titrated oxygen in this
60 minute optimisation period with the goal to reduce the need for non-invasive ventilation if
nasal high-flow therapy proofs to be more effective than titrated oxygen.
Methods
All potential participants had an initial paired arterial blood gas (ABG) and venous blood gas
(VBG) taken. If they were eligible, a 60-minute optimisation period followed after which
they received the second paired ABG and VBG samples to check for treatment failure.
Deferred consent was obtained and the already gathered data collected when patients were
stabilised.
Results
During roughly 3.5 months 120 people were admitted at the Emergency Department with a
primary diagnosis of AECOPD. 56 got an initial ABG and VBG to check for eligibility. Only
3 patients were initially included in the study and we managed to obtain consent in 2
participants. Due to these low recruitment numbers this study lacked statistical power to
answer most of the feasibility issues. We found lower proportions of both AECOPD and
AHRF in our cohort compared to international data. Furthermore we found that VBG’s are
accurate in determining acidosis but not in determining carbon dioxide compared to ABG,
which is currently the gold standard.
Conclusion
The study was prematurely terminated because sufficient data was collected to come to the
conclusion that it is not feasible to conduct a large randomised controlled trial to determine
the effect on NHF on patients with AECOPD and AHRF in New Zealand.






 
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