Post-extubation high-flow nasal cannula oxygen therapy versus non-invasive ventilation in chronic obstructive pulmonary disease with hypercapnic respiratory failure

The sequential use of non-invasive ventilation (NIV) for weaning in hypercapnic respiratory failure patients is a recommended practice. However, the effectiveness of weaning on high-flow nasal cannula (HFNC) is unclear. Chronic obstructive pulmonary disease patients with hypercapnic respiratory failure who received invasive ventilation were screened for enrollment. This study was a single-center, prospective, randomized comparative study. The primary outcome was treatment failure within 72 hours after extubation. Patients who were screened positive for extubation were enrolled in the study and randomized into the HFNC group and the NIV group using a computer-generated simple randomization chart. Treatment failure was defined as a return to invasive mechanical ventilation or a switch in respiratory support modality (i.e., changing from HFNC to NIV or from NIV to HFNC). The study included 62 of the 72 patients. Treatment failure occurred in 8 patients (26.67%) in the HFNC group and 8 patients in the NIV group (25%) (p=0.881). The mean duration of intensive care unit stay in the HFNC group was 5.47±2.26 days and 6.56±3.39 in the NIV group (p=0.376). In the current study, HFNC was non-inferior to NIV in preventing post-extubation respiratory failure in chronic obstructive pulmonary disease patients, while HFNC had better treatment tolerance.