Comparison of the effects of high-flow nasal cannula oxygen therapy and non-invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with hypoxemia

doi:10.3877/cma.j.issn.1674-6902.2025.05.013

Abstract

Abstract:

Objective

To compare the clinical effects of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypoxemia.

Methods

A total of 67 patients with AECOPD and hypoxemia admitted in our hospital from May 2021 to June 2024 were selected. Among them, 32 patients who received HFNC were assigned to the observation group, and 35 patients who received NIV were assigned to the control group. Vital signs, blood gas parameters, lung function, and inflammatory markers were compared between the two groups.

Results

After treatment, the respiratory rate (18.19±2.28) breaths/min and heart rate (81.05±7.20) beats/min in the observation group were lower than those in the control group (22.53±3.27) breaths/min, (85.36±8.04)beats/min (P<0.05). The arterial carbon dioxide partial pressure (PaCO₂) in the observation group was lower than before treatment (P<0.05), while the arterial oxygen partial pressure (PaO₂) and oxygenation index in both groups were higher than before treatment (P<0.05). After treatment, the forced vital capacity (FVC) (2.05±0.41)L, maximal voluntary ventilation (MVV) (50.86 ± 5.72)%, and forced expiratory volume in one second (FEV₁) (1.81±0.38)L in the observation group were higher than those in the control group FVC(1.73±0.35 L), MVV (42.54±4.65%), FEV₁ (1.42±0.33)L (P<0.05). The levels of serum surfactant protein-D (SP-D) (121.04±16.18) μg/L and pulmonary activation-regulated chemokine/CC type chemotactic factor 18 (PARC/CCL18) (80.06±9.23) μg/L in the observation group were lower than those in the control group SP-D(156.38±20.24)μg/L, PARC/CCL18 (95.19±12.05)μg/L (P<0.05). The rate of nasal and facial skin damage in the observation group (3.13%) was lower than that in the control group (20.00%) (P<0.05), and the comfort score in the observation group (8.72±0.30) was higher than that in the control group (5.80±0.64) (P<0.05). In the observation group, 30 patients survived (93.75%), and 2 died (6.25%), with the cause of death being respiratory failure. In the control group, 32 patients survived (91.43%), and 3 died (8.57%), with the causes of death being respiratory failure in 1 case and combined infection in 2 cases.

Conclusion

Both NIV and HFNC can regulate blood gas parameters in patients with AECOPD and hypoxemia, with favorable prognoses. However, compared to NIV, HFNC more effectively improves vital signs and lung function, reduces inflammatory responses, enhances comfort, and lowers the risk of nasal and facial skin damage.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Noninvasive ventilation, High-flow nasal cannula oxygen therapy, Hypoxemia

Liang Chang, Hanyu Wang, Yang Xu, Jianlong Wang, Bao Wang, Guoqiang Zheng, Weishan Hao, Xiaoyan Li. Comparison of the effects of high-flow nasal cannula oxygen therapy and non-invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with hypoxemia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(05): 737-741.

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References 23

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组　别	例数	呼吸频率(次/min)		平均动脉压(mmHg)		心率(次/min)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	29.67±4.58	18.19±2.28^a	86.21±5.73	88.23±5.98	95.38±9.12	81.05±7.20^a
对照组	35	28.13±4.25	22.53±3.27^a	88.54±6.26	86.38±6.37	98.54±9.67	85.36±8.04^a
t值		1.427	6.245	1.584	1.222	1.373	2.303
P值		0.158	0.000	0.118	0.226	0.174	0.024

组　别	例数	呼吸频率(次/min)		平均动脉压(mmHg)		心率(次/min)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	29.67±4.58	18.19±2.28^a	86.21±5.73	88.23±5.98	95.38±9.12	81.05±7.20^a
对照组	35	28.13±4.25	22.53±3.27^a	88.54±6.26	86.38±6.37	98.54±9.67	85.36±8.04^a
t值		1.427	6.245	1.584	1.222	1.373	2.303
P值		0.158	0.000	0.118	0.226	0.174	0.024

组　别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		PaO₂/FiO₂
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	65.87±13.51	49.32±9.74^a	48.96±5.21	62.20±8.81^a	178.34±20.61	235.45±28.17^a
对照组	35	61.30±11.05	51.26±8.30^a	51.38±6.54	59.45±7.65^a	186.25±22.57	225.83±26.97^a
t值		1.521	0.879	1.664	1.367	1.493	1.427
P值		0.133	0.382	0.101	0.176	0.140	0.158

组　别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		PaO₂/FiO₂
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	65.87±13.51	49.32±9.74^a	48.96±5.21	62.20±8.81^a	178.34±20.61	235.45±28.17^a
对照组	35	61.30±11.05	51.26±8.30^a	51.38±6.54	59.45±7.65^a	186.25±22.57	225.83±26.97^a
t值		1.521	0.879	1.664	1.367	1.493	1.427
P值		0.133	0.382	0.101	0.176	0.140	0.158

组　别	例数	FVC(L)		MVV(%)		FEV₁(L)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	1.20±0.29	2.05±0.41^a	34.42±3.26	50.86±5.72^a	1.12±0.25	1.81±0.38^a
对照组	35	1.25±0.27	1.73±0.35^a	34.17±3.35	42.54±4.65^a	1.16±0.23	1.42±0.33^a
t值		0.731	3.444	0.309	6.556	0.682	4.495
P值		0.467	0.001	0.758	0.000	0.497	0.000

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