The following is a summary of “Home high flow nasal cannula for chronic hypercapnic respiratory failure in COPD: A systematic review and meta-analysis,” published in the November 2023 issue of Pulmonology by Pitre, et al.

Patients with Chronic Obstructive Pulmonary Disease (COPD) and chronic hypercapnia are conventionally treated with non-invasive ventilation (NIV), but high flow nasal cannula (HFNC) presents itself as a potential alternative. However, the effectiveness of HFNC in COPD patients with chronic hypercapnia requires comprehensive evaluation.

Researchers conducted a systematic review and meta-analysis using random effects with inverse variance methods. They focused on randomized controlled trials involving adult COPD patients initiated on HFNC for at least one month. Key outcomes were all-cause mortality, acute exacerbations, hospitalizations, and changes in the St. George Respiratory Questionnaire (SGRQ). The risk of bias was evaluated using ROB 2.0, and GRADE assessed the quality of evidence.

Incorporating four randomized trials with 440 patients, the analysis indicated that HFNC likely reduces acute exacerbations compared to standard care (RR 0.77 [95% CI 0.66 to 0.89]; moderate certainty), translating to 69 fewer acute exacerbations per 1,000 patients. While HFNC may decrease hospital admissions (RR 0.87 [95% CI 0.69 to 1.09]; low certainty) and potentially lower SGRQ scores (MD 8.12 units lower [95% CI 13.30 to 2.95 lower]; low certainty), its impact on mortality remains uncertain (RR 1.22 [95% CI 0.64 to 2.35]; low certainty).

HFNC probably reduces acute exacerbations and potentially decreases hospital admissions for COPD patients with chronic hypercapnia. However, its influence on mortality remains uncertain. Future randomized controlled trials with larger sample sizes and extended follow-up periods were recommended to establish more robust evidence.

Source: resmedjournal.com/article/S0954-6111(23)00308-6/fulltext