Nilius Georg, Schroeder Maik, Domanski Ulrike, Khalaf Mohamed, Tatkov Stanislav
Klinikum Dortmund gGmbH, Dortmund, Germany.
University Witten/Herdecke, Witten, Germany.
ERJ Open Res. 2025 Jun 30;11(3). doi: 10.1183/23120541.01063-2024. eCollection 2025 May.
Nasal high flow (NHF) is an established treatment option in acute respiratory failure and has been shown to increase the elimination of carbon dioxide (CO) in hypercapnic COPD patients. The aim of the study was to investigate the impact on gas exchange, respiratory pattern and sleep quality in severe COPD patients with mild hypercapnic respiratory failure.
Hypercapnic COPD patients (n=42) underwent a wakefulness ventilation study with calibrated inductance plethysmography followed by two polysomnography (PSG) studies with NHF at 20 L·min and 35 L·min. In a crossover design immediately after hospital discharge, patients were randomised to a 4-week period of nocturnal NHF long-term oxygen therapy (LTOT). The primary outcome was transcutaneous carbon dioxide ( ) measured during PSG after each period.
NHF reduced mean overnight by 3.4±6.5 mmHg (p=0.010), attenuating the increase of CO during sleep, with no effect observed during wakefulness when minute ventilation (') and respiratory rate (RR) were decreased. The mean sleep fragmentation index (26.6±11.2) and sleep efficiency (72.8±16.4%) during NHF were not significantly different from those during LTOT (n=24). An increase in NHF did not change ' during wakefulness and did not produce significant effects on ventilation, gas exchange or sleep parameters during the night.
Nocturnal NHF attenuated an increase of during sleep in hypercapnic COPD patients without a relevant effect on sleep quality compared with LTOT. During wakefulness, was unaffected, but ' and RR were reduced, indicating a different physiological response during wakefulness compared with sleep.
经鼻高流量通气（NHF）是急性呼吸衰竭的一种既定治疗选择，并且已显示可增加高碳酸血症慢性阻塞性肺疾病（COPD）患者的二氧化碳（CO）清除。本研究的目的是调查轻度高碳酸血症呼吸衰竭的重度COPD患者中，NHF对气体交换、呼吸模式和睡眠质量的影响。
高碳酸血症COPD患者（n = 42）进行了校准电感体积描记法的清醒通气研究，随后进行了两次多导睡眠图（PSG）研究，分别采用20 L·min和35 L·min的NHF。在出院后立即采用交叉设计，将患者随机分为为期4周的夜间NHF长期氧疗（LTOT）组。主要结局是各阶段PSG期间测量的经皮二氧化碳（ ）。
NHF使平均夜间 降低了3.4±6.5 mmHg（p = 0.010），减轻了睡眠期间CO的增加，在分钟通气量（'）和呼吸频率（RR）降低时清醒期间未观察到影响。NHF期间的平均睡眠片段化指数（26.6±11.2）和睡眠效率（72.8±16.4%）与LTOT期间（n = 24）无显著差异。NHF增加在清醒期间未改变'，并且对夜间通气、气体交换或睡眠参数未产生显著影响。
与LTOT相比，夜间NHF减轻了高碳酸血症COPD患者睡眠期间 的增加，对睡眠质量无相关影响。在清醒期间， 未受影响，但'和RR降低，表明清醒期间与睡眠期间的生理反应不同。
