6533b7d5fe1ef96bd12650d5

RESEARCH PRODUCT

High Flow Nasal Therapy Use in Patients with Acute Exacerbation of COPD and Bronchiectasis: A Feasibility Study

Cesare GregorettiAndrea CortegianiNunzio CrimiAlberto NotoClaudia CrimiRaffaele CampisiEnrico Heffler

subject

Pulmonary and Respiratory MedicineMaleAcute exacerbation of chronic obstructive pulmonary diseasemedicine.medical_specialtyExacerbationbronchiectasishumidification03 medical and health sciencesPulmonary Disease Chronic Obstructivebronchiectasi0302 clinical medicineacute respiratory failure bronchiectasis COPD High flow nasal cannula humidification mucus plug sputumRespiratory RateInternal medicineMedicineCannulaHumansCOPDIn patientAcute respiratory failure030212 general & internal medicineProspective StudiesAgedCOPDBronchiectasisacute respiratory failurebusiness.industryOxygen Inhalation TherapysputumCarbon Dioxidemedicine.diseaseSymptom Flare UpHigh flow nasal cannulaMucusDyspnea030228 respiratory systemmucus plugSputumFeasibility StudiesFemalemedicine.symptomBlood Gas AnalysisbusinessHigh flow

description

The efficacy and feasibility of high flow nasal therapy (HFNT) use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and bronchiectasis is unknown. We performed a single-center, single-arm prospective observational study in patients with AECOPD, documented bronchiectasis, pH >= 7.35, respiratory rate (RR) >= 26 breaths/minute despite receiving maximal medical treatment and oxygen via face mask up to 10 L/m. Patients received HFNT (Airvo 2, Fisher & Paykel) at a gas flow of 50 L/min and FIO2 adjusted to maintain SpO(2) >= 92%. Dyspnea, rated by Borg scale, RR, arterial blood gases and mucus production (ranging from 1 to 3) were collected before and 1 h after starting HFNT and then every 24 h for 3 days. Tolerance was measured using a visual analogic scale (VAS). Fifteen patients were enrolled. After 24 h, patients showed a significant improvement in dyspnea score [Borg scale from 6.7 +/- 1.4 to 4.1 +/- 1.3 (p<.001)]; RR decreased from 29.6 +/- 2.7 breaths/min to 23.2 +/- 2.9 breaths/min (p<.001); pCO2 significantly decreased after 24 h [58.4 +/- 13 vs. 51.7 +/- 8.2 (p=.003)] while quantity of mucus production increased [(1.1 +/- 0,6 vs. 2.4 +/- 0.7, p<.001)]. No patient received invasive or noninvasive mechanical ventilation. Overall VAS score for HFNT tolerance was 6.5. HFNT was effective in improving dyspnea score, decreasing RR, improving gas exchange, and increasing mucus production in patients with AECOPD and coexisting bronchiectasis. Moreover, no safety concerns on its use were detected. Nevertheless, due to the single-arm design, the effect of HFNT could not be isolated from standard pharmacological treatment due to the study design.

yearjournalcountryeditionlanguage
2020-01-01
10.1080/15412555.2020.1728736http://hdl.handle.net/11570/3173450