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The impact of high⁃flow nasal cannula versus non⁃invasive mechanical ventilation in elderly patients experiencing acute exacerbation of chronic obstructive pulmonary disease with mild to moderate hypercapnia
Received date: 2025-01-06
Online published: 2025-05-20
Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy （HFNC） versus non-invasive positive pressure ventilation （NPPV） in elderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） accompanied by mild to moderate hypercapnia. Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021， to October 2023， with 49 in the NPPV group and 43 in the HFNC group. The two groups were compared in terms of 28-day intubation rate， 90-day mortality， and arterial blood gases. Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group （28.57% vs. 11.63%， P < 0.05）， but no significant differences in the 90-day mortality rate （36.73% vs. 23.26%， P > 0.05）. The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group （Log-Rank test： χ2 = 4.257， P = 0.039）， but no significant difference in 90-day mortality rate （Log-Rank test： χ2 = 2.596， P = 0.107）. A Cox proportional hazards model， which incorporated APACHE II score and baseline PaCO2， demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69% as compared to the NPPV group （HR = 0.31， 95%CI：0.10 ~ 0.93， P = 0.037）， but the risk of 90-day mortality did not show a significant decrease （HR = 0.61， 95%CI：0.27 ~ 1.37， P = 0.232）. PaCO2 in both groups decreased gradually and pH increased simultaneously. PaCO2， pH， and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups （P > 0.05）. Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia， HFNC reduces intubation rates compared to NPPV， without increasing mortality， and shows similar improvements in arterial blood gas indicators， making it a suitable respiratory support option.
Li AN , Xiaomiao XIONG , Minsheng LI , Wei JIANG , Yanxin LIU , Zhijian ZHANG . The impact of high⁃flow nasal cannula versus non⁃invasive mechanical ventilation in elderly patients experiencing acute exacerbation of chronic obstructive pulmonary disease with mild to moderate hypercapnia[J]. The Journal of Practical Medicine, 2025 , 41(9) : 1332 -1338 . DOI: 10.3969/j.issn.1006-5725.2025.09.009
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