High-Flow Nasal Oxygen Therapy for Exacerbation of Chronic Pulmonary Obstructive Disease.
High-Flow Nasal Oxygen Therapy for Exacerbation of Chronic Pulmonary Obstructive Disease.
High-Flow Nasal Oxygen (HFNO) therapy has never been tested against Noninvasive ventilation,
 the reference standard therapy for acute exacerbation of chronic obstructive pulmonary
 disease (COPD), in randomized clinical trials.

 The aim of the present study is to compare the effects of HFNO therapy on arterial blood gas
 variables over the first 24 hours of therapy, to those of Noninvasive ventilation, in
 patients experiencing a moderate (i.e. with arterial pH within 7.25-7.35) exacerbation of
 COPD.
As soon as admission to the intensive care unit, eligible patients who gave consent will be
 randomized to either HFNO or Noninvasive ventilation therapy for at least the first 24 hours.

 In the usual care group , Noninvasive ventilation will be applied in alternance with standard
 nasal oxygen therapy.

 In the intervention group, HFNO with be applied continuously over the first 24 hours.

 In both groups, an oxygen saturation, as assessed by finger pulse oximetry, of 88-92% will be
 targeted.

 The primary objective will be two-fold: to compare between groups 1) Efficacy, assessed by
 the arterial pH at 24 hours, and 2) Safety, assessed by the ratio of the arterial partial
 pressure in oxygen (PaO2) over the inspired oxygen fraction (FiO2) at 24 hours.
Inclusion Criteria:

 -  Age > 18

 -  Known Chronic Obstructive Pulmonary disease (COPD)

 -  respiratory rate or presence of accessory respiratory muscles activity on physical
 exam

 -  moderate exacerbation of COPD as defined by an arteria pH between 7.25 and 7.35 and an
 arterial carbon dioxide partial pressure (PaCO2) equal or above 45 mm Hg

 Exclusion Criteria:

 -  Age below 18

 -  Pregnancy

 -  Known sleep apnea syndrome

 -  Patent treated by noninvasive ventilation at home

 -  Not affiliated to French scial security

 -  Contraindication to aither Noninvasive ventilation or to High-Flow Nasal Oxygen
 therapy

 -  Previous inclusion in the study