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Summary: High-Velocity Nasal Insufflation VS Noninvasive Positive Pressure Ventilation for COPD Exacerbation
Topic: Primary Support
Yamane D.P., Jones C. & Wilkerson G. et. al., 42: High-Velocity Nasal Insufflation VS Noninvasive Positive Pressure Ventilation for COPD Exacerbation. Critical Care Medicine 52(1):p S21, January 2024. DOI: 10.1097/01.ccm.0000998556.81699.a8
Yamane and colleagues conducted a randomized, multicenter study to evaluate the efficacy of high velocity therapy or HVNI (Precision Flow; Vapotherm, Inc, Exeter, NH) compared to noninvasive positive pressure ventilation (NIPPV), for treatment of patients with COPD presenting with moderate to severe acute hypercapnic respiratory failure.
The study included 68 adult patients presenting to the emergency department with known or suspected COPD with acute hypercapnic respiratory failure with an initial PCO2 of 60 mmHg or higher and pH of 7.0-7.35 on blood gas. Exclusions included need for emergent intubation, severe metabolic derangements, primary condition of congestive heart failure, and presence of significant pneumonia on chest imaging.
Treatment failure occurred in 4 of 36 subjects (11.1%) in the high velocity therapy group and 6 of 32 subjects (18.8%) in the NIPPV group (p=0.498). The data demonstrated that over 4 hours, the absolute change in PCO2 was similar between the 2 groups (HVNI: -10.6 ± 13.3mmHg vs NIPPV: -8.5 ± 14.1mmHg, p=0.563). The mean PCO2 fell from 77.8 ± 13.6mmHg to 68.7± 13.9mmHg in the high velocity therapy cohort and 76.5 ± 13.6mmHg to 69.0 ± 20.3mmHg in the NIPPV cohort.
The authors concluded that the study results suggest that with similar physiological benefit, treatment with high velocity therapy is a reasonable alternative to NIPPV and may lead to reduced rates of intubation for patients unable to tolerate NIPPV.
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CAUTION: US Federal law restricts this device to sale by or on the order of a physician. Indications, contraindications, warnings, and instructions for use can be found in the product labelling supplied with each device or at https://vapotherm.com/resources/support/precision-flow-reference/. For spontaneously breathing patients. High Velocity Therapy (HVT) does not provide total ventilatory requirements of the patient. It is not a ventilator. Decisions surrounding patient care depend on the physician’s professional judgment in consideration of all available information for the individual case, including escalation of care depending on patient condition.