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Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD.
Bräunlich, Jens; Dellweg, Dominic; Bastian, Andreas; Budweiser, Stephan; Randerath, Winfried; Triché, Dora; Bachmann, Martin; Kähler, Christian; Bayarassou, Abdel Hakim; Mäder, Irmhild; Geiseler, Jens; Köhler, Norbert; Petroff, David; Wirtz, Hubert.
Afiliación
  • Bräunlich J; Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany.
  • Dellweg D; Fachkrankenhaus Kloster Grafschaft GmbH , Schmallenberg Grafschaft, Germany.
  • Bastian A; Pneumologie/Intensivmedizin/Infektiologie, Marienkrankenhaus Kassel , Kassel, Germany.
  • Budweiser S; Medizinische Klinik III, RoMed Klinikum Rosenheim, Rosenheim, Germany.
  • Randerath W; Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany.
  • Triché D; Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nürnberg, Germany.
  • Bachmann M; Intensivmedizin und Beatmungsmedizin, Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Asklepios Klinikum Harburg, Hamburg, Germany.
  • Kähler C; Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria.
  • Bayarassou AH; Klinik für Pneumologie, Kardiologie, Schlaf- und Beatmungsmedizin, Malteser Krankenhaus Seliger Gerhard, Bonn/Rhein-Sieg, Bonn, Germany.
  • Mäder I; Zentralklinik Bad Berka GmbH, Klinik für Pneumologie, Bad Berka, Germany.
  • Geiseler J; Medizinische Klinik IV, Klinikum Vest - Paracelsus-Klinik Marl, Marl, Germany.
  • Köhler N; Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany.
  • Petroff D; Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany.
  • Wirtz H; Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany.
Int J Chron Obstruct Pulmon Dis ; 14: 1411-1421, 2019.
Article en En | MEDLINE | ID: mdl-31308647
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 (pCO2≥50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO2 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/m2, 90% GOLD D, pCO2 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<0.001) from baseline using NIV (indistinguishable to intention-to-treat analysis). The difference of pCO2 changes between the two devices was -1.4 mmHg (95% CI -3.1-0.4, P=0.12). Both devices had positive impact on blood gases and respiratory scores (St. George's Respiratory Questionnaire, Severe Respiratory Insufficiency Questionnaire). Conclusions: NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, eg, those not tolerating or rejecting NIV with respect to pCO2 reduction and improvement in QoL.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia por Inhalación de Oxígeno / Enfermedad Pulmonar Obstructiva Crónica / Ventilación no Invasiva / Hipercapnia / Pulmón Tipo de estudio: Clinical_trials / Diagnostic_studies Aspecto: Patient_preference Límite: Aged / Humans / Middle aged País/Región como asunto: Europa Idioma: En Revista: Int J Chron Obstruct Pulmon Dis Año: 2019 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Nueva Zelanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia por Inhalación de Oxígeno / Enfermedad Pulmonar Obstructiva Crónica / Ventilación no Invasiva / Hipercapnia / Pulmón Tipo de estudio: Clinical_trials / Diagnostic_studies Aspecto: Patient_preference Límite: Aged / Humans / Middle aged País/Región como asunto: Europa Idioma: En Revista: Int J Chron Obstruct Pulmon Dis Año: 2019 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Nueva Zelanda