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.
Department of Emergency Medicine, University of Tennessee, Chattanooga, TN, United States; Erlanger Health System, Chattanooga, TN, United States.
Heart Lung. 2020 Sep-Oct;49(5):610-615. doi: 10.1016/j.hrtlng.2020.03.008. Epub 2020 Apr 6.
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.
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 and pH over time. Secondary outcomes were treatment failure and intubation rate.
65 patients with hypercapnic respiratory failure were compared. 34 were randomized to HVNI and 31 to NIPPV. The therapeutic impact on PCO 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).
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.
高流量鼻导管（HFNC）供氧在提供呼吸支持方面非常有效。HFNC 可清除胸外死腔，因此在治疗高碳酸血症性呼吸衰竭方面具有潜在益处。本研究比较了高流速鼻内吹气（HVNI），一种 HFNC 形式，与无创正压通气（NIPPV）在为高碳酸血症性呼吸衰竭患者提供通气支持方面的能力。
这是一项对需要 NIPPV 支持的呼吸衰竭急诊科（ED）患者进行的更大规模随机临床试验的预先定义的亚组分析。患者被随机分配到 HVNI 或 NIPPV。亚组选择是针对出院诊断为急性高碳酸血症性呼吸衰竭或慢性阻塞性肺疾病急性加重的患者进行的。主要结局是 pCO 和 pH 随时间的变化。次要结局是治疗失败和插管率。
比较了 65 例高碳酸血症性呼吸衰竭患者。34 例随机分配到 HVNI 组，31 例随机分配到 NIPPV 组。每组在时间上对 PCO 和 pH 的治疗影响相似。HVNI 组的插管率为 5.9%，NIPPV 组为 16.1%（p=0.244）。HVNI 组的治疗失败率为 23.5%，NIPPV 组为 25.8%（p=1.0）。
HVNI 可能为急性高碳酸血症性呼吸衰竭患者提供与 NIPPV 相似的通气支持，但需要进一步研究来证实这些发现。
