The Use of High-Flow Nasal Oxygen Therapy in the Management of Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Feasibility Study

OBJECTIVE: This study investigated the efficacy of high-flow nasal oxygen therapy in patients with severe acute exacerbation of chronic obstructive pulmonary disease admitted to the intensive care unit. MATERIAL AND METHODS: Totally, 23 patients were enrolled in the study. High-flow nasal oxygen therapy was administered with a predefined protocol. Vital signs, Visual Analog Scale for dyspnea, and arterial blood gas parameters were recorded at the beginning under low-flow oxygen support therapy and the 1st, 6th, 12th, and 24th hours of high-flow nasal oxygen therapy. High-flow nasal oxygen therapy duration, intensive care unit length of stay, and intensive care unit, in-hospital, and 60-day mortality were recorded as outcomes and compared according to the presence of pneumonia upon admission. RESULTS: In 12 patients (52.2%), pneumonia was present. High-flow nasal oxygen therapy was applied for a median of 57 hours [49.2-104.5]. Overall decreases were detected in heart rate (P=.001), respiratory rate (P<.001), and Visual Analog Scale for dyspnea (P=.001) during the first 24 hours of the therapy. Although there was an increase in PaCO2 (P=.001), pH increased (P<.001) over time too. No change in partial arterial oxygen pressure (P=.63) and partial arterial oxygen pressure/fraction of inspired oxygen ratio (P=.22) was noted. Nineteen patients (77%) were successfully weaned from high-flow nasal oxygen therapy. While the high-flow nasal oxygen therapy failure rate was 23%, the in-hospital and 60-day mortality rates were 8.6%. Outcomes were not different between patients with and without pneumonia. CONCLUSION: High-flow nasal oxygen therapy was efficient in relieving respiratory distress and well-tolerated with no adverse outcome in severe acute exacerbation of chronic obstructive pulmonary disease patients admitted to the intensive care unit.