TRANSNASAL HIGH-FLOW OXYGEN THERAPY VERSUS NON-INVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH TYPE II RESPIRATORY FAILURE
DOI:
https://doi.org/10.69980/cc1tm957Keywords:
Mechanical Ventilation, Oxygen Therapy, Hypercapnia, Hypoxemia, Pulmonary MedicineAbstract
Background: Non-invasive ventilation (NIV) is the standard of care for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with type II respiratory failure. However, patient discomfort and interface intolerance often limit its use. Transnasal high-flow oxygen therapy (TNHFOT) has emerged as a potential alternative that may improve tolerance while maintaining gas exchange.
Aim & Objectives: This prospective comparative study aimed to compare the safety and efficacy of TNHFOT versus NIV in AECOPD patients with type II respiratory failure. Objectives included assessing effectiveness, clinical outcomes, and duration of ICU stay.Methods: 70 patients with AECOPD and type II respiratory failure (PaCO₂ >45 mmHg, RR >25) were enrolled at Osmania Medical College, Hyderabad, and divided equally into TNHFOT (n=35) and NIV (n=35) groups. TNHFOT was delivered at 30-60 L/min with FiO₂ 100%. NIV was delivered via BiPAP with IPAP 15 cm H₂O, EPAP 6 cm H₂O, and PEEP 6. Respiratory variables including ABG, SpO₂, and RR were measured 12th hourly.Results: Most patients were aged 65-70 years with male predominance. Treatment failure rates were 25.7% in the HFNC group vs 14.3% in the NIV group. Invasive ventilation was required in 14.3% of HFNC patients vs 5.7% of NIV patients (P = 0.026). Length of ICU stay was 7 days for HFNC vs 9 days for NIV (P = 0.059). 28-day mortality was 8.6% for HFNC vs 5.7% for NIV (P = 0.485).Conclusion: Both TNHFOT and NIV are viable options for managing AECOPD with type II respiratory failure. NIV showed lower treatment failure and invasive ventilation rates. However, TNHFOT was associated with better patient tolerance and a trend toward shorter ICU stay. TNHFOT may serve as a comfortable and effective alternative to NIV in select patients.
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