Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD
Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD
复制标题
DOI：
10.2147/copd.s206111
复制
发表时间：
2019-01-01
影响因子：
2.8
通讯作者：
Wirtz, Hubert
中科院分区：
文献类型：
--
作者：
Braeunlich, Jens;Dellweg, Dominic;Wirtz, Hubert
背景：尽管在慢性高碳酸血症COPD患者中应用无创机械通气(NIV)取得了令人鼓舞的结果，但也很明显，一些患者不能耐受NIV或不能从中受益。方法：采用多中心、随机、对照、交叉设计，在2011-2016年间，患者先接受6周的NHF机械通气，然后再接受6周的NIV机械通气(TIBICO)，反之亦然。COPD患者白天有稳定的高碳酸血症(PCO(2)和GT；=50毫米汞柱)，来自13个德国中心。结果：102例患者(平均+/-SD)年龄65.3+/-9.3岁，61%女性，体重指数23.1+/-4.8 kg/m(2)，90%金D，PCO(2)56.5+/-5.4 mm Hg。使用NHF后，二氧化碳水平降低了4.7%(n=94；全分析集；95%CI1.8-7.5，P=0.002)，降低了7.1%(95%CI4.1-10.1，P=0.05)。
Background: Despite the encouraging results of noninvasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and nasal high-flow (NHF) to compare effectiveness.Methods: In a multi-centered, randomized, controlled, cross-over design, patients received 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia(pCO(2)>= 50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO(2) changes from baseline blood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device use were secondary endpoints.Results: A total of 102 patients (mean +/- SD) age 65.3 +/- 9.3 years, 61% females, body mass index 23.1 +/- 4.8 kg/m(2), 90% GOLD D, pCO(2) 56.5 +/- 5.4 mmHg were randomized. PCO2 levels decreased by 4.7% (n=94; full analysis set; 95% CI 1.8-7.5, P=0.002) using NHF and 7.1% (95% CI 4.1-10.1, P