The use of high-flow versus conventional oxygen therapy in addition to noninvasive ventilation in exacerbated COPD patients in the ICU: A retrospective cohort study in 351 patients

Background and aim: The optimal treatment strategy for acute exacerbation of COPD in the ICU next to the well-known benefits of noninvasive ventilation (NIPPV) is unknown. We hypothesised that High Flow Nasal Cannula (HFNC) as noninvasive respiratory support plus NIPPV could add additional help compared to conventional oxygen therapy (COT) plus NIPPV. Methods: We conducted a retrospective analysis. We included 351 patients admitted to ICU with AECOPD and need for NIPPV. Survival was assessed with Kaplan-Meier curves and the Log-rank test. Cox proportional hazard regression models were used to analyse differences in survival between treatment groups. Results: 126 patients were treated with HFNC plus NIPPV. 225 patients received COT plus NIPPV. Median pH and hypercapnia only showed slight differences on admission. ICU stay was 4 days in both groups. The need for invasive ventilation was alike in both groups (HFNC 18.3% vs COT 17.8%). In a cox regression model for 30-day mortality, patients treated with HFNC showed a 2.17 (0.99e4.78) higher hazard for mortality compared to the COT group (p 1/4 0.054). Conclusion: According to our data HFNC in combination with noninvasive positive pressure ventilation does not seem to provide additional benefits over COT in combination with noninvasive positive pressure ventilation in terms of 30-day mortality and need for intubation. (c) 2023 Elsevier Ltd. All rights reserved.