Comparing High Flow Nasal Cannula and Non-Invasive Ventilation for COPD Exacerbations

High Flow Nasal Cannula Versus Non-Invasive Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease and Hypercapnic Respiratory Failure

This study is testing whether High Flow Nasal Cannula or Non-Invasive Ventilation works better to help people with COPD feel more comfortable and breathe easier during flare-ups.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: 40 Years and up
• Sex: All
• Sponsor: Unity Health Toronto (Academic / other)
• Locations: 1 site (Toronto, Ontario)
• Trial ID: NCT03033251 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the effectiveness of High Flow Nasal Cannula (HFNC) compared to Non-Invasive Ventilation (NIV) in patients experiencing exacerbations of Chronic Obstructive Pulmonary Disease (COPD) and acute hypercapnic respiratory failure. Participants will be randomly assigned to receive both treatments in a controlled setting, with each intervention lasting up to 30 minutes. The study aims to assess the physiological responses and tolerability of each method in a Medical-Surgical ICU environment. The primary focus is on improving patient comfort and respiratory function during acute episodes.

Who should consider this trial

Good fit: Ideal candidates are adults over 40 years old with COPD exacerbation and acute hypercapnic respiratory failure.

Not a fit: Patients requiring urgent intubation or those with severe respiratory acidosis may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could provide a more comfortable and effective method for managing acute respiratory distress in COPD patients.

How similar studies have performed: Previous studies have shown promising results with HFNC in similar patient populations, suggesting potential benefits over traditional NIV.

Eligibility criteria

Inclusion Criteria:

1. COPD exacerbation and acute hypercapnic respiratory failure with acute respiratory failure defined by

   * Respiratory acidosis (pH ≤7.35 and PaCO2 ≥45 mmHg);
   * Respiratory rate≥20 breaths/min;
   * Activation of accessory respiratory muscles;
2. Undergone at NIV or HFNC since their admission
3. English speaking
4. Adult patient with age \> 40 year old.

Exclusion Criteria:

1. Severe respiratory acidosis defined by pH\<7.25
2. Decreased level of consciousness (Glasgow Coma Score Scale \< 11)
3. Urgent intubation required
4. Pneumothorax with pleural drainage and persistent air leak
5. Hemodynamic instability requiring vasopressors
6. Uncooperative
7. Patients with skin or chest wall or abdominal trauma (potentially worsened by placement of a surface sensor)
8. Clinical judgement of the attending physician
9. Body mass index \> 40 kg/m2

Where this trial is running

Toronto, Ontario

• St. Michael's Hospital — Toronto, Ontario, Canada (Recruiting)

Study contacts

• Study coordinator: Laurent Brochard, MD

Conditions Exacerbation Copd; Acute Respiratory Distress; Acute Hypercapnic Respiratory Failure; COPD exacerbation; Work of breathing; Non invasive ventilation; High Flow Oxygen Cannula