@article {Br{\"a}unlich39, author = {Jens Br{\"a}unlich and Dominic Dellweg and Andreas Bastian and Torsten-Gerriet Blum and Stephan Budweiser and Winfried Randerath and Dora Trich{\'e} and Martin Bachmann and Christian K{\"a}hler and Abdel Hakim Bayarassou and Irmhild M{\"a}der and Jens Geiseler and David Petroff and Norbert K{\"o}hler and Hubert Wirtz}, title = {Nasal high-flow versus non-invasive ventilation in patients with chronic hypercapnic COPD}, volume = {6}, number = {suppl 4}, elocation-id = {39}, year = {2020}, doi = {10.1183/23120541.RFMVC-2020.39}, publisher = {European Respiratory Society}, abstract = {Background: Despite the encouraging results of non-invasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and NHF to compare effectiveness.Methods: In a multi-centered, randomized, controlled, cross-over design, patients received six weeks of NHF ventilation followed by six weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO2>= 50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO2changes from baseline Blood gas, lung function, quality of life, the 6 minute walking test, and duration of device use were secondary endpoints.Results: 102 patients (mean+SD) age 65.3{\textpm}9.3 years, 61\% females, BMI 23.1{\textpm}4.8 kg/m2, 90\% GOLD D, pCO2 56.5{\textpm}5.4 mmHg were randomized. PCO2levels decreased by 4.7\% (n=94; full analysis set; 95\% CI 1.8 to 7.5, p=0.002) using NHF and 7.1\% (95\% CI 4.1 to 10.1, p\<0.001) from baseline using NIV (indistinguishable to intention-to-treat analysis). The difference of pCO2changes between the two devices was -1.4 mmHg (95\% CI -3.1 to 0.4, p=0.12). Both devices had positive impact on blood gases and respiratory scores (SGRQ, SRI).Conclusions: NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, e.g. those not tolerating or rejecting NIV with respect to pCO2reduction and improvement in quality of life.Registration: www.clinicaltrials.gov NCT02007772FootnotesCite this article as: ERJ Open Research 2020; 6: Suppl. 4, 39.This is an ERS Respiratory Failure and Mechanical Ventilation Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).}, URL = {https://openres.ersjournals.com/content/6/suppl_4/39}, eprint = {https://openres.ersjournals.com/content}, journal = {ERJ Open Research} }