Written by Ketan Patel
Spoon Feed
High-velocity nasal insufflation (HVNI) was non-inferior to noninvasive positive pressure ventilation (NiPPV) for treating acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department.
Blowin’ in the wind – HVNI vs. NiPPV in the battle of the breaths
This randomized controlled trial evaluated HVNI and NiPPV in relieving perceived dyspnea up to 4 hours in ED patients with acute hypercapneic COPD exacerbations. Sixty-eight patients with COPD exacerbations, pCO2 ≥ 60 mm Hg, and venous pH 7.0–7.35 were randomized to HVNI (n=36) or NiPPV (n=32). Patients with HVNI were noninferior to NiPPV in reducing dyspnea at 4 hours (Borg score: 3.17 ± 2.59 vs. 3.34 ± 2.04, p=0.03). In secondary outcome analyses, no significant differences were found in pCO2 levels, pH, patient discomfort, and need for intubation between groups. Of note, patients in the HVNI group reported better overall comfort at 30 and 60 minutes as well as 4 hours (p = 0.003). This research was industry funded by Vapotherm, Inc., and several authors received grant funding or compensation from them.
How does this change my practice?
Many factors play a role in my management of acute COPD exacerbations. NiPPV is a life saver, but I encounter patients who refuse it or can’t tolerate it due to anxiety or discomfort, usually due to claustrophobia. Having HVNI as an option besides endotracheal intubation for persistent respiratory failure is a win for patients who do not tolerate NiPPV.
Source
High-velocity nasal insufflation versus noninvasive positive pressure ventilation for moderate acute exacerbation of chronic obstructive pulmonary disease in the emergency department: A randomized clinical trial. Acad Emerg Med. 2024 Dec 11. doi: 10.1111/acem.15038. Epub ahead of print. PMID: 39663589
