Effects of sequential noninvasive ventilation combined with high-flow nasal cannula oxygen therapy after extubation in patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Xinyuan , CHENG Jiangli ,  LIANG Guopeng

Department of Respiratory Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIANG Guopeng, Email: liangguopeng007@163.com

Keywords：

Chronic obstructive pulmonary disease; high-flow nasal cannula oxygen therapy; noninvasive ventilation; respiratory failure

DOI：

10.7507/1671-6205.202505083

Video：

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Objective To investigate the efficacy and safety of noninvasive ventilation (NIV) combined with high-flow nasal cannula oxygen therapy (HFNC) versus NIV as sequential post-extubation therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This retrospective cohort study enrolled AECOPD patients managed with invasive mechanical ventilation and sequential post-extubation therapy at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were divided into a NIV group and a NIV-HFNC group based on sequential therapy modality. Outcomes included blood gas parameters (at 24h and 48h post-extubation), 7-day delirium incidence post-extubation, 7-day reintubation rate, 28-day mortality, NIV duration, intensive care unit (ICU) length of stay and hospital length of stay. Subgroup analyses were performed for the patients not reintubated within 48h post-extubation. Results A total of 156 patients were included, with 81 patients in the NIV group and 75 patients in the NIV-HFNC group. At 24h and 48h post-extubation, the NIV-HFNC group showed significantly lower PaCO₂ (t=3.123, P=0.002; t=4.791, P<0.001) and HCO₃^– (t=2.313, P=0.022; t=4.605, P<0.001) levels, while pH (t=–2.287, P=0.024) at 48h was significantly higher than that in the NIV group. The 7-day reintubation rate (χ²=14.381, P<0.001) and the NIV duration (z=–3.495, P<0.001) were both significantly lower in the NIV-HFNC group than those in the NIV group. No significant differences were observed in 7-day delirium incidence, 28-day mortality, ICU or hospital length of stay (all P>0.05). Subgroup analyses showed that PaO₂ at 48h post-extubation was significantly higher in the NIV-HFNC subgroup compared with the NIV subgroup (t=–2.390, P=0.018) while reintubation rate (χ²=4.693, P=0.030) and NIV duration (z=–4.936, P<0.001) were consistent with the overall results. Conclusion Compared with sequential NIV alone, NIV combined with HFNC as sequential therapy for AECOPD patients demonstrates superiority in improving post-extubation blood gas parameters, reducing reintubation rate and shortening NIV duration, offering a novel post-extubation respiratory support option to improve outcomes.

Citation： YANG Xinyuan, CHENG Jiangli, LIANG Guopeng. Effects of sequential noninvasive ventilation combined with high-flow nasal cannula oxygen therapy after extubation in patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(11): 761-766. doi: 10.7507/1671-6205.202505083 Copy

1.	中國醫學裝備協會呼吸病學裝備技術專業委員會, 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組, 廣東省藥學會. 穩定期慢性阻塞性肺疾病醫藥共管專家共識. 中華結核和呼吸雜志, 2022, 45(10): 980-987.
2.	Christenson SA, Smith BM, Bafadhel M, et al. Chronic obstructive pulmonary disease. Lancet, 2022, 399: 2227-2242.
3.	Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Arch Bronconeumol, 2023, 59(4): 232-248.
4.	慢性阻塞性肺疾病急性加重診治專家組. 慢性阻塞性肺疾病急性加重診治中國專家共識(2023年修訂版). 國際呼吸雜志, 2023, 43(2): 132-149.
5.	王辰, 商鳴宇, 黃克武, 等. 有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的研究. 中華結核和呼吸雜志, 2000, 23(4): 212-216.
6.	Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 2020, 46(5): 888-906.
7.	Tan D, Walline JH, Ling B, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Crit Care, 2020, 24(1): 489.
8.	Hernández G, Paredes I, Moran F, et al. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial. Intensive Care Med, 2022, 48(12): 1751-1759.
9.	中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 2019, 42(2): 83-91.
10.	談定玉, 凌冰玉, 孫家艷, 等. 經鼻高流量氧療與無創正壓通氣比較治療慢性阻塞性肺疾病合并中度呼吸衰竭的觀察性隊列研究. 中華急診醫學雜志, 2018, 27(4): 361-366.
11.	Qin J, Wang G, Liao Y, et al. High flow nasal therapy versus noninvasive ventilation for AECOPD with acute hypercapnic respiratory failure: a meta-analysis of randomized controlled trials. Ann Intensive Care, 2025, 15(1): 64.
12.	楊小雪, 卓越, 丁偉超, 等. 慢性阻塞性肺疾病急性加重機械通氣患者序貫HFNC與NPPV的療效比較. 國際麻醉學與復蘇雜志, 2022, 43(1): 29-33.
13.	方國強, 萬秋風, 田雅潔, 等. AECOPD致嚴重呼吸衰竭患者早期拔管后序貫經鼻高流量濕化氧療與無創正壓通氣的優劣比較. 中華危重病急救醫學, 2021, 33(10): 1215-1220.
14.	曹鵬, 凌冰玉, 徐艷, 等. 有創-高流量氧療與有創-無創通氣序貫治療慢性阻塞性肺疾病并嚴重呼吸衰竭的隨機對照研究. 中國呼吸與危重監護雜志, 2021, 20(6): 388-395.
15.	Richard JM, Beloncle FM, Béduneau G, et al. Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial. Intensive Care Med, 2024, 50(10): 1647-1656.
16.	王嬌, 鄭秋蘭, 曾聰, 等. 基于精神心理因素構建的重癥監護病房患者譫妄危險預測模型. 中國中西醫結合急救雜志, 2024, 31(2): 223-228.
17.	王旭, 侯澤娟, 竇偉. 經鼻高流量氧療聯合無創正壓通氣治療慢性阻塞性肺疾病合并呼吸衰竭患者的效果中國臨床實用醫學, 2020, 11(1): 60-63.
18.	Fu X, Wang L, Wang G, et al. Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study. BMC Pulm Med, 2022, 22(1): 266.
19.	Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive care unit delirium: a review of diagnosis, prevention, and treatment. Anesthesiology, 2016, 125(6): 1229-1241.
20.	Ní Chróinín D, Alexandrou E, Frost SA. Delirium in the intensive care unit and its importance in the post-operative context: a review. Front Med (Lausanne), 2023, 10: 1071854.
21.	Longhini F, Bruni A, Garofalo E, et al. Monitoring the patient-ventilator asynchrony during non-invasive ventilation. Front Med (Lausanne), 2022, 9: 1119924.
22.	Cammarota G, Simonte R, De Robertis E. Comfort during non-invasive ventilation. Front Med (Lausanne), 2022, 9: 874250.
23.	王鑫, 穆士偉, 王孝俠, 等. 經鼻高流量氧療在慢性阻塞性肺疾病急性加重無創通氣后序貫治療中的應用效果. 中國中西醫結合急救雜志, 2022, 29(3): 292-296.
24.	Corley A, Rickard CM, Aitken LM, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev, 2017, 5(5): Cd010172.
25.	Jing G, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health, 2019, 42(3): 217-225.
26.	楊圣強, 劉貞, 孟素秋, 等. 無創通氣聯合經鼻高流量氧療在慢性阻塞性肺疾病機械通氣患者撤機后序貫治療中的應用價值. 中華醫學雜志, 2020, 100(27): 2116-2120.

1. 中國醫學裝備協會呼吸病學裝備技術專業委員會, 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組, 廣東省藥學會. 穩定期慢性阻塞性肺疾病醫藥共管專家共識. 中華結核和呼吸雜志, 2022, 45(10): 980-987.
2. Christenson SA, Smith BM, Bafadhel M, et al. Chronic obstructive pulmonary disease. Lancet, 2022, 399: 2227-2242.
3. Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. Arch Bronconeumol, 2023, 59(4): 232-248.
4. 慢性阻塞性肺疾病急性加重診治專家組. 慢性阻塞性肺疾病急性加重診治中國專家共識(2023年修訂版). 國際呼吸雜志, 2023, 43(2): 132-149.
5. 王辰, 商鳴宇, 黃克武, 等. 有創與無創序貫性機械通氣治療慢性阻塞性肺疾病所致嚴重呼吸衰竭的研究. 中華結核和呼吸雜志, 2000, 23(4): 212-216.
6. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 2020, 46(5): 888-906.
7. Tan D, Walline JH, Ling B, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Crit Care, 2020, 24(1): 489.
8. Hernández G, Paredes I, Moran F, et al. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: a randomized trial. Intensive Care Med, 2022, 48(12): 1751-1759.
9. 中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 2019, 42(2): 83-91.
10. 談定玉, 凌冰玉, 孫家艷, 等. 經鼻高流量氧療與無創正壓通氣比較治療慢性阻塞性肺疾病合并中度呼吸衰竭的觀察性隊列研究. 中華急診醫學雜志, 2018, 27(4): 361-366.
11. Qin J, Wang G, Liao Y, et al. High flow nasal therapy versus noninvasive ventilation for AECOPD with acute hypercapnic respiratory failure: a meta-analysis of randomized controlled trials. Ann Intensive Care, 2025, 15(1): 64.
12. 楊小雪, 卓越, 丁偉超, 等. 慢性阻塞性肺疾病急性加重機械通氣患者序貫HFNC與NPPV的療效比較. 國際麻醉學與復蘇雜志, 2022, 43(1): 29-33.
13. 方國強, 萬秋風, 田雅潔, 等. AECOPD致嚴重呼吸衰竭患者早期拔管后序貫經鼻高流量濕化氧療與無創正壓通氣的優劣比較. 中華危重病急救醫學, 2021, 33(10): 1215-1220.
14. 曹鵬, 凌冰玉, 徐艷, 等. 有創-高流量氧療與有創-無創通氣序貫治療慢性阻塞性肺疾病并嚴重呼吸衰竭的隨機對照研究. 中國呼吸與危重監護雜志, 2021, 20(6): 388-395.
15. Richard JM, Beloncle FM, Béduneau G, et al. Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial. Intensive Care Med, 2024, 50(10): 1647-1656.
16. 王嬌, 鄭秋蘭, 曾聰, 等. 基于精神心理因素構建的重癥監護病房患者譫妄危險預測模型. 中國中西醫結合急救雜志, 2024, 31(2): 223-228.
17. 王旭, 侯澤娟, 竇偉. 經鼻高流量氧療聯合無創正壓通氣治療慢性阻塞性肺疾病合并呼吸衰竭患者的效果中國臨床實用醫學, 2020, 11(1): 60-63.
18. Fu X, Wang L, Wang G, et al. Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study. BMC Pulm Med, 2022, 22(1): 266.
19. Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive care unit delirium: a review of diagnosis, prevention, and treatment. Anesthesiology, 2016, 125(6): 1229-1241.
20. Ní Chróinín D, Alexandrou E, Frost SA. Delirium in the intensive care unit and its importance in the post-operative context: a review. Front Med (Lausanne), 2023, 10: 1071854.
21. Longhini F, Bruni A, Garofalo E, et al. Monitoring the patient-ventilator asynchrony during non-invasive ventilation. Front Med (Lausanne), 2022, 9: 1119924.
22. Cammarota G, Simonte R, De Robertis E. Comfort during non-invasive ventilation. Front Med (Lausanne), 2022, 9: 874250.
23. 王鑫, 穆士偉, 王孝俠, 等. 經鼻高流量氧療在慢性阻塞性肺疾病急性加重無創通氣后序貫治療中的應用效果. 中國中西醫結合急救雜志, 2022, 29(3): 292-296.
24. Corley A, Rickard CM, Aitken LM, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev, 2017, 5(5): Cd010172.
25. Jing G, Li J, Hao D, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health, 2019, 42(3): 217-225.
26. 楊圣強, 劉貞, 孟素秋, 等. 無創通氣聯合經鼻高流量氧療在慢性阻塞性肺疾病機械通氣患者撤機后序貫治療中的應用價值. 中華醫學雜志, 2020, 100(27): 2116-2120.

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Effects of sequential noninvasive ventilation combined with high-flow nasal cannula oxygen therapy after extubation in patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study

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