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Summary: The ventilatory effect of high velocity nasal insufflation compared to non-invasive positive-pressure ventilation in the treatment of hypercapneic respiratory failure: a subgroup analysis
Topic: Primary Support
Doshi P, Whittle JS, Dungan G, et al. The ventilatory effect of high velocity nasal insufflation compared to non-invasive positive-pressure ventilation in the treatment of hypercapneic respiratory failure: a subgroup analysis. Heart Lung. 2020;49(5):610-615.
Doshi and colleagues published the results of a pre-defined subgroup analysis, in Heart Lung in 2020, from a larger randomized clinical trial of Emergency Department (ED) patients with respiratory failure requiring noninvasive positive-pressure ventilation (NiPPV) support1. In the study, patients were randomized to high velocity nasal insufflation (HVNI) or NIPPV.
In this subgroup analysis, 65 patients with hypercapnic respiratory failure were randomized and compared (34 to HVNI and 31 to NiPPV). Subgroup selection was done for patients with discharge diagnoses of acute hypercapnic respiratory failure or acute exacerbation of chronic obstructive pulmonary disease (COPD). The primary outcomes were change in pCO2 and pH over time. Secondary outcomes were treatment failure and intubation rate. The therapeutic impact on pCO2 and pH over time was similar in each group. The intubation rate was 5.9% in the HVNI group and 16.1% in the NiPPV group (p = 0.244). The rate of treatment failure was 23.5% in the HVNI group and 25.8% in the NiPPV group (p = 1.0).
The study showed that HVNI is efficacious in improving PaCO2 levels over time, and it may be considered another noninvasive ventilation therapy that is available to manage patients with acute hypercapnic respiratory failure. Further study is needed to corroborate these findings.
SOURCES:
1.) Doshi et al High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Ann Emerg Med 2018; 72:73-83 e5
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