High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease

The physiological effects of high-flow nasal cannula O 2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O 2 therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O 2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O 2 saturation target of 88–92%. Gas exchange, breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and work of breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTP DI/min )) were recorded. EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O 2 , and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O 2 : p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTP DI/min increased from 135 ± 60 to 211 ± 70 cmH 2 O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O 2 : p < 0.05 versus HFNC1 and HFNC2). In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and work of breathing compared with conventional O 2 therapy.