A feasibility study of nasal high flow therapy in patients presenting with an acute exacerbation of chronic obstructivepulmonary disease with acute hypercapnic respiratory failure.

Baarsma, J.P. (Jan Pieter) (2017) A feasibility study of nasal high flow therapy in patients presenting with an acute exacerbation of chronic obstructivepulmonary disease with acute hypercapnic respiratory failure. thesis, Medicine.

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Abstract

COPD represents a major public health challenge worldwide. About 20% of people presenting with an acute exacerbation of COPD (AECOPD) will develop acute hypercapnic respiratory failure (AHRF). Currently, after a 60-minute optimisation period, non-invasive ventilation is often required to assist with a patient’s ventilation. This feasibility study collected data to seek answers for the feasibility issues which are needed to accurately plan a large randomised controlled trial comparing nasal high-flow therapy to titrated oxygen in this 60 minute optimisation period with the goal to reduce the need for non-invasive ventilation if nasal high-flow therapy proofs to be more effective than titrated oxygen. Methods All potential participants had an initial paired arterial blood gas (ABG) and venous blood gas (VBG) taken. If they were eligible, a 60-minute optimisation period followed after which they received the second paired ABG and VBG samples to check for treatment failure. Deferred consent was obtained and the already gathered data collected when patients were stabilised. Results During roughly 3.5 months 120 people were admitted at the Emergency Department with a primary diagnosis of AECOPD. 56 got an initial ABG and VBG to check for eligibility. Only 3 patients were initially included in the study and we managed to obtain consent in 2 participants. Due to these low recruitment numbers this study lacked statistical power to answer most of the feasibility issues. We found lower proportions of both AECOPD and AHRF in our cohort compared to international data. Furthermore we found that VBG’s are accurate in determining acidosis but not in determining carbon dioxide compared to ABG, which is currently the gold standard. Conclusion The study was prematurely terminated because sufficient data was collected to come to the conclusion that it is not feasible to conduct a large randomised controlled trial to determine the effect on NHF on patients with AECOPD and AHRF in New Zealand.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Kocks, Janwillem
Supervisor name:	Second supervisor: and Fingleton, James and Location: Medical Research Institute of New Zealand (MRINZ) and Wellington Hospital and Department: Respiratory medicine/ Emergency department
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:01
Last Modified:	25 Jun 2020 11:01
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2166

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