A Comparative Study between High Flow Nasal Cannula and the Standard Continuous Positive Airway Pressure Ventilation in Preventing Post-extubation Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Ataya, Emad A.; Kamel, Reda K.; Ismail, Samir E.; ABD EL RAHMAN, AHMED H.

doi:10.21608/bmfj.2025.388088.2433

A Comparative Study between High Flow Nasal Cannula and the Standard Continuous Positive Airway Pressure Ventilation in Preventing Post-extubation Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Document Type : Original Article

Authors

¹ MBBCh, MSc in critical care medicine

² Professor of Anesthesia , Intensive Care Faculty of Medicine, Benha University

³ Assistant Professor of Anesthesia , Intensive Care Faculty of Medicine, Benha University

⁴ Assistant Professor of Anesthesia , Intensive Care Faculty of Medicine- Benha University

10.21608/bmfj.2025.388088.2433

Abstract

Background: Chronic obstructive pulmonary disease (COPD) exacerbations often lead to respiratory failure, with post-extubation respiratory failure (PERF) being a major concern. Non-invasive ventilation methods such as high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) improve oxygenation and reduce re-intubation risk, yet comparative research post-extubation in COPD is limited. Aim: To assess the effectiveness of HFNO and CPAP in preventing PERF and reintubation in COPD cases after mechanical ventilation (MV) weaning. Secondary goals included ICU and hospital stay duration and ICU mortality.Methods: This randomized controlled study was conducted at Benha University Hospitals' Critical Care Department from November 1st, 2022, to October 31st, 2023. It involved COPD exacerbation cases with respiratory failure weaned from MV. After meeting criteria and giving consent, patients were randomized into two groups: GROUP I (30 received HFNO for 24h post-extubation) and GROUP II (30 received CPAP for the same period).Results: The HFNO group showed greater effectiveness in preventing PERF, though mortality, reintubation rates, and ICU stay were similar between groups. PERF was lower in the HFNO group (8%) vs. CPAP group (11%). Reintubation rates: 20% for HFNO vs. 23.3% for CPAP.Conclusion: HFNO was linked to a reduced reintubation rate after extubation compared to CPAP. Patients managed with HFNO also had higher PaO₂ two hours post-extubation. Hospital stay and mortality were comparable. HFNO helped reduce reintubation in COPD patients with prior MV >72h. Those weaned with HFNO also showed improved PaO₂, lower respiratory rate, and higher mean blood pressure during the 24h observation.

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