A44-24 Oxygen Therapy in Acute and Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Rationale Oxygen therapy strategies for pre-hospital and in-hospital in acute and stable Chronic obstructive pulmonary disease (COPD) are still debated. Research argue that Excess oxygen may worsen hypercapnia and/or hypoxemia. This registered systematic review evaluates randomized clinical trials (RCTs) comparing oxygen-delivery modalities in acute and stable COPD and their effects on oxygenation, ventilation, and clinical outcomes. Methods Following PRISMA guidelines, PubMed and Embase were searched up to October 2025 for RCTs in COPD. Eligible studies assessed high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT). The reported outcomes such as mortality, arterial blood gases, dyspnea, and vital signs were extracted. Three independent reviewers performed selection, extraction, and risk-of-bias assessment. Data were summarized narratively. Registration PROSPERO: CRD420251153379 Results Out of 234 articles, 9 RCTs (n = 1,372) met inclusion criteria. All studies were conducted between 2010 and 2025. Four RCTs compared HFNC with COT. Five RCTs compared HFNC with COT in either AECOPD or stable COPD. Across all studies the flow rates ranged from 30 to 60 L/min in HFNC to keep SpO2 ≥ 92 %. Across studies, HFNC improved oxygenation (SpO2 from 93 % vs 95 %, p < 0.05) and PaO2 (from 70 to 120 mmHg, p < 0.05) while reducing respiratory rate and dyspnea. No change or reduction was identified on PaCO2. HFNC provides better oxygenation compared to COT. HFNC is considered more comfortable and less annoying for patients. Mortality was similier with HFNC and COT. No study reported oxygen-related adverse events. Conclusion HFNC delivers better oxygenation compared to COT and indicates better tolerance. mortality and hypercapnia risk were similar across studies. Findings support integrating HFNC and strict oxygenation goals into clinical practice guidelines for both acute and stable COPD management.