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.

Autor: Doshi PB; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Jesse Jones Library #271, 6431 Fannin St. Houston, TX 77030, United States; Division of Critical Care, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States; Memorial Hermann Hospital - Texas Medical Center, Houston, TX, United States., Whittle JS; Department of Emergency Medicine, University of Tennessee, Chattanooga, TN, United States; Erlanger Health System, Chattanooga, TN, United States., Dungan G 2nd; Vapotherm, Inc., Exeter, NH, United States; Canisius College, Buffalo, NY, United States., Volakis LI; Vapotherm, Inc., Exeter, NH, United States., Bublewicz M; Memorial Hermann The Woodlands Hospital, The Woodlands, TX, United States., Kearney J; McLeod Regional Medical Center, Florence, SC, United States., Miller TL; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Palestine, State of; Vixiar Medical, Baltimore, MD., Dodge D; Division of Critical Care, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States., Harsch MR; Technomics Research, LLC, Minneapolis, MN, United States., DeBellis R; Vapotherm, Inc., Exeter, NH, United States., Chambers KA; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Jesse Jones Library #271, 6431 Fannin St. Houston, TX 77030, United States. Electronic address: Kimberly.a.chambers@uth.tmc.edu.
Jazyk: angličtina
Zdroj: Heart & lung : the journal of critical care [Heart Lung] 2020 Sep - Oct; Vol. 49 (5), pp. 610-615. Date of Electronic Publication: 2020 Apr 06.
DOI: 10.1016/j.hrtlng.2020.03.008
Abstrakt: Purpose: Oxygen delivery by high flow nasal cannula (HFNC) is effective in providing respiratory support. HFNC has utility in clearing the extra-thoracic dead space, making it potentially beneficial in the treatment of hypercapnic respiratory failure. This study compares high velocity nasal insufflation (HVNI), a form of HFNC, to non-invasive positive pressure ventilation (NIPPV) in their abilities to provide ventilatory support for patients with hypercapnic respiratory failure.
Methods: This is a pre-defined subgroup analysis from a larger randomized clinical trial of Emergency Department (ED) patients with respiratory failure requiring NIPPV support. Patients were randomized to HVNI or NIPPV. Subgroup selection was done for patients with discharge diagnoses of acute hypercapnic respiratory failure or acute exacerbation of chronic obstructive pulmonary disease. The primary outcomes were change in pCO 2 and pH over time. Secondary outcomes were treatment failure and intubation rate.
Results: 65 patients with hypercapnic respiratory failure were compared. 34 were randomized to HVNI and 31 to NIPPV. The therapeutic impact on PCO 2 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).
Conclusion: HVNI may provide ventilatory support similar to NIPPV in patients presenting with acute hypercapnic respiratory failure, but further study is needed to corroborate these findings.
Competing Interests: Declaration of Competing Interest None
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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