ObjectiveTo systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. MethodsThe Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. ResultA total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. ConclusionsCompared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.
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.