Comparing High Flow Nasal Cannula and Non-Invasive Ventilation for Severe COPD Exacerbations with Respiratory Failure

What this Trial Is About

Chronic obstructive lung disease COPD is a disabling condition often caused by long-term tobacco smoke exposure, affecting millions worldwide and marked by episodes of worsening symptoms called exacerbations. These exacerbations can cause severe breathlessness requiring hospitalizations and sometimes admission to an Intensive Care Unit ICU for respiratory support. This research evaluates a newer technique called High Flow Nasal Cannula HFNC compared to the standard non-invasive ventilation NIV in patients with severe COPD exacerbations and hypercapnic respiratory failure. The study aims to determine if HFNC is not inferior to NIV in helping with breathing effort and if it offers better patient comfort since it does not require a mask. Participants will receive both HFNC and NIV treatments during the study. HFNC will be delivered at flow rates of 30 and 50 liters per minute in random order, with temperature settings adjusted for comfort. NIV settings will be managed by respiratory therapists following standard care and remain constant during testing. Each device will be applied for up to 30 minutes, with a 5-minute oxygen therapy washout between conditions. The entire procedure lasts up to 3 hours and takes place in a medical-surgical ICU setting. No additional follow-up occurs after the study. During the study, participants will be monitored continuously with pulse oximetry and transcutaneous CO2 measurements. Ultrasound exams will assess diaphragm and other respiratory muscle thickness and activity at specific time points. Researchers will record breathing effort and muscle activity under spontaneous breathing and during each ventilation support method. The primary outcome measures the change in work of breathing between NIV and HFNC after 30 minutes. Secondary outcomes compare work of breathing between the two HFNC flow rates. Safety and tolerance are closely observed, and the study ends promptly if clinical intolerance occurs.

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