High Flow Nasal Oxygen for Exacerbation COPD

Summary

In this pilot study the feasibility of performing a larger trial to study the non-inferiority of High Flow Nasal Oxygen compared to non-invasive ventilation in patients with acute acidotic hypercapnic exacerbation of COPD wil be investigated

Eligibility

Inclusion Criteria:

* Known chronic obstructive pulmonary disease
* Acute hypercapnic exacerbation of this condition, defined as: PaCO2\>45 mmHg or \>6.0 kPa and pH 7.20-7.35
* Age \>40 years

Exclusion Criteria:

* Asthma
* Immediate need for intubation, based on clinical judgement of the attending physician.
* Impossibility to apply either one of the two interventions
* Patient not expected to give immediate or delayed informed consent (e.g. known cognitive impairment, dementia, active serious psychiatric disease, mental retardation).
* Established home-NIV or home CPAP, known indication for home-NIV or CPAP (e.g. OSAS or obesitas hypoventilation syndrome).
* Impeding death
* Concurrent (respiratory) diseases that may influence treatment efficacy: acute heart infarction, cardiogenic lung edema, massive pulmonary embolism (intermediate-high risk or more). NB; pulmonary infections (viral and bacterial) are a common cause of exacerbation and are no reason for exclusion.
* Other acute diseases that preclude participation in the trial such as hemodynamic instability (need for vasopressors), reduced consciousness with need for intubation, severe intoxication
* Tracheostomized patients
* Participation in other interventional trials
* Impossibility to admit the patient to the participating ICU or monitored ward (e.g. medium care / high dependency unit, depending on local infrastructure).
* Previous explicit (or written) objection to participation in research - bicarbonate \<20 mmol/L

Conditions2

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