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      Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD

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          Despite the encouraging results of noninvasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and nasal high-flow (NHF) to compare effectiveness.


          In a multi-centered, randomized, controlled, cross-over design, patients received 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO 2≥50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO 2 changes from baseline blood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device use were secondary endpoints.


          A total of 102 patients (mean±SD) age 65.3±9.3 years, 61% females, body mass index 23.1±4.8 kg/m 2, 90% GOLD D, pCO 2 56.5±5.4 mmHg were randomized. PCO 2 levels decreased by 4.7% (n=94; full analysis set; 95% CI 1.8–7.5, P=0.002) using NHF and 7.1% (95% CI 4.1–10.1, P<0.001) from baseline using NIV (indistinguishable to intention-to-treat analysis). The difference of pCO 2 changes between the two devices was −1.4 mmHg (95% CI −3.1–0.4, P=0.12). Both devices had positive impact on blood gases and respiratory scores (St. George’s Respiratory Questionnaire, Severe Respiratory Insufficiency Questionnaire).


          NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, eg, those not tolerating or rejecting NIV with respect to pCO 2 reduction and improvement in QoL.

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          Most cited references 33

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          Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome.

          Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce.
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            Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial.

            Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking.
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              Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.

              High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                05 July 2019
                : 14
                : 1411-1421
                [1 ] Department of Respiratory Medicine, University of Leipzig AöR , Leipzig, Germany
                [2 ] Fachkrankenhaus Kloster Grafschaft GmbH , Schmallenberg Grafschaft, Germany
                [3 ] Pneumologie/Intensivmedizin/Infektiologie, Marienkrankenhaus Kassel , Kassel, Germany
                [4 ] Medizinische Klinik III, RoMed Klinikum Rosenheim , Rosenheim, Germany
                [5 ] Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin , Solingen, Germany
                [6 ] Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg , Nürnberg, Germany
                [7 ] Intensivmedizin und Beatmungsmedizin, Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Asklepios Klinikum Harburg , Hamburg, Germany
                [8 ] Department of Internal Medicine, Innsbruck Medical University , Innsbruck, Austria
                [9 ] Klinik für Pneumologie, Kardiologie, Schlaf- und Beatmungsmedizin, Malteser Krankenhaus Seliger Gerhard, Bonn/Rhein-Sieg , Bonn, Germany
                [10 ] Zentralklinik Bad Berka GmbH, Klinik für Pneumologie , Bad Berka, Germany
                [11 ] Medizinische Klinik IV, Klinikum Vest - Paracelsus-Klinik Marl , Marl, Germany
                [12 ] Clinical Trial Centre Leipzig, University of Leipzig , Leipzig, Germany
                Author notes
                Correspondence: Jens BräunlichDepartment of Respiratory Medicine, University of Leipzig AöR , Liebigstrasse 20, Leipzig04103, GermanyTel +49 341 971 2450 Email highflow@
                © 2019 Bräunlich et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (

                Page count
                Figures: 2, Tables: 3, References: 38, Pages: 11
                Original Research

                Respiratory medicine

                hypercapnia, noninvasive ventilation, nasal high-flow, copd


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