J Korean Med Sci.  2020 Mar;35(10):e67. 10.3346/jkms.2020.35.e67.

High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study

  • 1Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.
  • 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea.
  • 3Medical Information Center of Ulsan University Hospital, Ulsan, Korea.
  • 4Department of Emergency Medicine, Ulsan University Hospital, Ulsan, Korea.
  • 5Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. pastnumber@hanmail.net


Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia.
All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching.
A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups.
In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.


Oxygen Inhalation Therapy; Respiratory Insufficiency; Noninvasive Ventilation; Hypercapnia; Propensity Score

MeSH Terms

Cohort Studies*
Hospital Mortality
Intensive Care Units
Lung Diseases
Noninvasive Ventilation
Oxygen Inhalation Therapy
Propensity Score
Prospective Studies
Respiratory Insufficiency*
Retrospective Studies*
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