{
  "abstract": "High-flow nasal therapy (HFT) is a non-invasive respiratory support widely used in hypoxemic respiratory failure. However, evidence of HFT in hypercapnic patients, particularly in chronic obstructive pulmonary disease (COPD) exacerbations, remains limited. A recent prospective, randomised, single-centre study by Haciosman et al (Am J Emerg Med 2025; DOI:10.1016 /j.ajem.2024.10.043) compared HFT at 30 L/min, HFT at 50 L/min, and non-invasive ventilation (NIV) in 137 patients admitted to the emergency department with acute COPD exacerbation, hypercapnic respiratory failure with respiratory acidosis, and no response to initial bronchodilators and corticosteroids. Primary outcomes were blood gas changes (pH, PaCO₂, lactate, bicarbonate) at baseline, 30, 60, and 120 min. Secondary outcomes included the need for intubation, ICU admission, hospital stay, and 28-day mortality. All modalities showed comparable efficacy in reducing PaCO₂ and improving pH at 30 and 120 min. However, HFT at 30 L/min led to a significantly greater reduction in PaCO₂ at 60 min (p=0.042), contrasting with previous studies where HFT showed no superiority. No significant differences were observed in intubation rates, mortality, or bicarbonate levels (possibly due to short follow-up). Use of HFT at 30 L/min was associated with higher patient satisfaction and greater emergency department discharge rates than NIV (p=0.018 and p=0.002, respectively), suggesting better tolerance. This study supports HFT at 30 L/min as a potential alternative to NIV, especially when NIV is contraindicated, and highlights the importance of flow settings in optimising patient comfort and outcomes in selected COPD patients.",
  "authors": [
    {
      "affiliations": [
        "Pulmonology, Hospital de Santa Marta, Lisbon, Portugal"
      ],
      "name": "Inês Duarte"
    }
  ],
  "title": "Journal club",
  "uid": "ebd2d6ea-6902-5540-ac16-23cb3b28649b"
}