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Twelve (44%) received HFNC, and 15 (56%) received NIV. Median of changes in PaCO2 from baseline to after 1 h of treatment were 7 mm Hg (IQR 4-11, P = .002) for HFNC and 3 mm Hg (IQR 1-8, P = .02) for NIV, with no between-group difference. pH, breathing frequency and signs of work of breathing also improved after both HFNC and NIV. CONCLUSION This preliminary study suggests that HFNC treatment for 1 h improves PaCO2 and respiratory parameters in subjects with hypercapnic acute CPE in a manner that is comparable to NIV. Further studies