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Background <p>Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often present with hypercapnic respiratory failure, requiring noninvasive ventilatory support. While noninvasive ventilation (NIV) is well established, high-flow nasal cannulas (HFNC) are increasingly used. This meta-analysis evaluated the comparative effectiveness of HFNC and standard NIV in adult patients with AECOPD.</p> Methods <p>A systematic search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science through March 2025 for randomized controlled trials comparing high-flow nasal cannula (HFNC) with noninvasive ventilation (NIV) in hypercapnic acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data were synthesized using a random-effects model. The primary outcomes included the partial pressure of carbon dioxide (PaCO₂), treatment failure, and the need for intubation. Secondary outcomes included respiratory rate, comfort score, arterial pH, mortality, length of hospital stay, complications, and treatment intolerance. This meta-analysis followed the PRISMA guidelines and was registered in PROSPERO (ID: CRD420251001760).</p> Results <p>Six randomized controlled trials involving 640 patients (HFNC: 324; NIV: 316) were included in the analysis. HFNC was associated with lower PaCO₂ (−5.94&#xa0;mmHg), reduced respiratory rate (−2.67 breaths/min), and shorter hospital stay (−1.26&#xa0;days). It also reduced the odds of treatment failure (OR = 0.56), need for intubation (OR = 0.49), complications (OR = 0.39), and treatment intolerance (OR = 0.24). Comfort scores were higher (MD = 1.77), and pH levels showed slight improvement (MD = 0.03). The difference in mortality was not statistically significant (OR = 0.40, <i>p</i> = 0.06).</p> Conclusion <p>HFNC demonstrates comparable efficacy to NIV in managing AECOPD with hypercapnic respiratory failure and has notable advantages in terms of patient comfort and tolerance compared to NIV. HFNC offers an effective and better-tolerated alternative to NIV in appropriately selected patients with AECOPD.</p>

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Clinical Effectiveness of High-Flow Nasal Cannula Versus Non-invasive Ventilation in Acute COPD Exacerbations: A GRADE-Assessed Systematic Review and Meta-analysis with Trial Sequential Analysis of Randomized Controlled Trials

  • 期刊论文

  • 发表日期：

    2025年10月23日

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  • Wajahat Mirza,
  • Syed Murtaza Hassan Kazmi,
  • Muhammad Sajeel Turab,
  • Muhammad Moaz,
  • Sundus Dadan,
  • Nosheen Kazmi

摘要

Background

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often present with hypercapnic respiratory failure, requiring noninvasive ventilatory support. While noninvasive ventilation (NIV) is well established, high-flow nasal cannulas (HFNC) are increasingly used. This meta-analysis evaluated the comparative effectiveness of HFNC and standard NIV in adult patients with AECOPD.

Methods

A systematic search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science through March 2025 for randomized controlled trials comparing high-flow nasal cannula (HFNC) with noninvasive ventilation (NIV) in hypercapnic acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data were synthesized using a random-effects model. The primary outcomes included the partial pressure of carbon dioxide (PaCO₂), treatment failure, and the need for intubation. Secondary outcomes included respiratory rate, comfort score, arterial pH, mortality, length of hospital stay, complications, and treatment intolerance. This meta-analysis followed the PRISMA guidelines and was registered in PROSPERO (ID: CRD420251001760).

Results

Six randomized controlled trials involving 640 patients (HFNC: 324; NIV: 316) were included in the analysis. HFNC was associated with lower PaCO₂ (−5.94 mmHg), reduced respiratory rate (−2.67 breaths/min), and shorter hospital stay (−1.26 days). It also reduced the odds of treatment failure (OR = 0.56), need for intubation (OR = 0.49), complications (OR = 0.39), and treatment intolerance (OR = 0.24). Comfort scores were higher (MD = 1.77), and pH levels showed slight improvement (MD = 0.03). The difference in mortality was not statistically significant (OR = 0.40, p = 0.06).

Conclusion

HFNC demonstrates comparable efficacy to NIV in managing AECOPD with hypercapnic respiratory failure and has notable advantages in terms of patient comfort and tolerance compared to NIV. HFNC offers an effective and better-tolerated alternative to NIV in appropriately selected patients with AECOPD.