{
  "abstract": "Background: Acute exacerbations of chronic obstructive pulmonary disease complicated by acute hypercapnia require respiratory support. Respiratory acidosis requires support that is often provided with high-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV). Our aim is to compare the efficacy and safety of the two modalities.\n\nMethods: We conducted a systematic review and meta-analysis of randomised controlled trials including patients with acute hypercapnia and respiratory acidosis following PRISMA guidelines. Searches were performed on PubMed, Scopus and Web of Science. The primary outcome was intubation/invasive mechanical ventilation. Secondary outcomes included mortality types, crossover to the other support modality, length of stay, physiological parameters and adverse events. Pooled estimates from random effects models (inverse-variance weights and DerSimonian-Laird estimator) were expressed as risk ratios (RR) or mean differences (MD) with 95% CI.\n\nResults: Ten trials were included. The risk of intubation was similar between HFNO and NIV (RR 1.25, 95% CI 0.83 to 1.90). Crossover from HFNO to NIV was more frequent (RR 2.18, 95% CI 1.07 to 4.41). Mortality outcomes (28–30 day mortality: RR 1.11, 95% CI 0.66 to 1.89, hospital: RR 0.49, 95% CI 0.16 to 1.49) did not differ. Low-certainty evidence suggested a shorter length of stay with HFNO (MD –0.79 days, 95% CI –1.41 to –0.18).\n\nConclusions: No statistically significant differences were found between HFNO and NIV for intubation and mortality for patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory acidosis. Provided crossover to the other therapy was allowed, more patients crossed over from HFNO to NIV. HFNO was associated with shorter LOS.",
  "abstract_shown": true,
  "affiliations": [
    "Hospital Medicine, Beverly Hospital, Beverly, Massachusetts, USA",
    "Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA",
    "Respiratory Medicine, Queen’s Medical Centre, Nottingham, Nottingham, UK",
    "University of Derby, Derby, England, UK",
    "Respiratory Medicine, United Lincolnshire Hospitals NHS Trust, Lincoln, England, UK",
    "University of Thessaly School of Health Sciences, Larissa, Greece",
    "Department of Emergency Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Paraschos Archontakis Barakakis",
      "orcid": "0000-0002-6660-6916"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Milind Sovani",
      "orcid": "0000-0003-3841-2652"
    },
    {
      "affs": [
        2
      ],
      "name": "Rahul Eric",
      "orcid": "0009-0000-8628-6545"
    },
    {
      "affs": [
        2
      ],
      "name": "Midhina Ravikumar",
      "orcid": "0009-0002-8070-689X"
    },
    {
      "affs": [
        2
      ],
      "name": "Jaikirat Singh Gugnani",
      "orcid": "0000-0003-3502-7425"
    },
    {
      "affs": [
        4
      ],
      "name": "Chii Haw Hon",
      "orcid": "0009-0006-2220-1702"
    },
    {
      "affs": [
        2
      ],
      "name": "Nilakantha Sumanam"
    },
    {
      "affs": [
        5
      ],
      "name": "Georgios Mavrovounis",
      "orcid": "0000-0001-7595-5598"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Ioannis Pantazopoulos",
      "orcid": "0000-0002-8846-519X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bc6xtfkxz96ka.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjresp-2026-004442",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13735329/",
  "id": "bc6xtfkxz96ka",
  "issns": [
    "2052-4439"
  ],
  "landing_url": "https://doi.org/10.1136/bmjresp-2026-004442",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "2215"
    ],
    [
      "heading",
      "Chronic Obstructive Pulmonary Disease"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2740|Respiratory Support and Mechanisms"
    ]
  ],
  "openalex": "W7225109717",
  "pdf_url": "https://bmjopenrespres.bmj.com/content/13/1/e004442.full.pdf",
  "pmcid": "PMC13735329",
  "pmid": "42971727",
  "published": "2026-11-02",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/bc6xtfkxz96ka.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:02Z",
      "native_id": "PMC13735329",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjresp-2026-004442"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Respiratory Support and Mechanisms",
      "subfield": "general"
    }
  ],
  "title": "High-flow nasal oxygen versus non-invasive ventilation in patients with acute hypercapnic exacerbation of COPD: a systematic review and meta-analysis of randomised controlled trials",
  "title_text": "High-flow nasal oxygen versus non-invasive ventilation in patients with acute hypercapnic exacerbation of COPD: a systematic review and meta-analysis of randomised controlled trials",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:02Z",
  "url": "https://research.draconitic.com/paper/bc6xtfkxz96ka",
  "venue": "BMJ Open Respiratory Research",
  "versions": []
}