High-Flow Nasal Cannula for Acute Exacerbations of COPD?

Noninvasive positive-pressure ventilation (NPPV) is a guideline-recommended standard for patients with moderate hypercapnic respiratory failure during acute exacerbations of chronic obstructive pulmonary disease (COPD); however, high-flow nasal cannulas (HFNC) might provide better patient comfort and might lower CO₂ levels more rapidly (J Int Med Res 2023; 51:3000605231182558). Investigators in China compared these two modalities by randomizing 228 patients with acute exacerbations of COPD and moderate hypercapnic respiratory failure (pH, 7.25–7.35; pCO₂, ≥50 mm Hg) to HFNC or NPPV.

Treatment failure — endotracheal intubation or switch to the other therapy — occurred significantly more often among patients who received HFNC than in those who…