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High-flow nasal cannula (HFNC) therapy is increasingly used in the management of acute respiratory failure. Its clinical application has been expanded also in other specific settings In stable COPD patients and in those recovering from acute exacerbation, HFNC can reduce PaCO2, respiratory rate, minute ventilation and respiratory effort.
The aim of this randomized crossover physiological study is to investigate the effects on PaCO2 levels of two different nasal cannula ('Optiflow + Duet' interface vs "standard" nasal interface) in COPD patients with persistent hypercapnia following an acute severe exacerbation
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HFNC 40 L/min with conventional symmetric nasal cannula | Active Comparator | The patients will be asked to breathe with HFNC at flow of 40 L/min with standard interface |
|
| HFNC 40 L/min with new asymmetric nasal cannula | Active Comparator | The patients will be asked to breathe with HFNC at flow of 40 L/min with the new asymmetric nasal cannula |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AIRVO 2, with conventional symmetric nasal cannula | Device | The patients will be asked to breathe with HFNC at flow of 40 L/min with the standard cannula The size of nasal cannula will be selected to occlude patient's nostril of about 2/3. Temperature will be set according to the patient's tolerance starting from 31°C, up to 37°C, while FiO2 is adjusted to maintain SpO2 between 88 and 92%. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes of the partial pressure of carbon dioxide (PaCO2) levels | Arterial Blood Gases will be analyzed from a sample taken from the arterial artery | immediately after intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory Rate ( RR), (b/min) | This parameter will be measured by a bioelectrical impedance monitor and a single-use Pad Set sensor that will be placed on the surface of the chest wall (ExSpiron, Respiratory Motion) Inc. USA) | 90 minutes |
| Tidal Volume ( TV), (mL) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| IRCCS Policlinico di Sant'Orsola | Bologna | 40138 | Italy |
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| ID | Term |
|---|---|
| D029424 | Pulmonary Disease, Chronic Obstructive |
| D006935 | Hypercapnia |
| ID | Term |
|---|---|
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
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|
|
| AIRVO 2, the new asymmetric nasal cannula | Device | The patients will be asked to breathe with HFNC at flow of 40 L/min with the new asymmetric nasal cannula The size of nasal cannula will be selected to occlude patient's nostril of about 2/3. Temperature will be set according to the patient's tolerance starting from 31°C, up to 37°C, while FiO2 is adjusted to maintain SpO2 between 88 and 92%. |
|
|
This parameter will be measured by a bioelectrical impedance monitor and a single-use Pad Set sensor that will be placed on the surface of the chest wall (ExSpiron, Respiratory Motion) Inc. USA) |
| 90 minutes |
| Minute Ventilation (VE), (L/min) | This parameter will be measured by a bioelectrical impedance monitor and a single-use Pad Set sensor that will be placed on the surface of the chest wall (ExSpiron, Respiratory Motion) Inc. USA) | 90 minutes |
| Inspiratory effort quantification | Esophageal pressure assessment through dedicated esophageal pressure transducer ( (Marquat Genie Biomedical,France) | 90 minutes |
| Transcutaneous carbon dioxide (TcPCO2) and oxygen saturation (SpO2) | TcPCO2 and SpO2 will be recorded by using a dedicated device (SenTec AG, Therwil, Switzerland) | 90 minutes |
| Dyspnea score | Dyspnea will be recorded using the Borg scale that is a numeric scale where 0 is no dyspnea and 10 the maximal dyspnea that a patient can imagine | immediately after intervention |
| Comfort | this will be assessed by using the Visual Numerical Scale ranging between 1 (extreme discomfort) and 5 (very comfortable), | immediately after intervention |
| D020969 |
| Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |