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<h2><strong>Title:</strong> <a href="https://umem.org/educational_pearls/4676/">High-Intensity NIPPV for Acute COPD Exacerbations</a></h2>
<p><strong>Category:</strong> <a href="https://umem.org/educational_pearls/?category=10">Critical Care</a></p>
<p>
<strong>Posted:</strong> 12/17/2024 by <a href="https://umem.org/educational_pearls/?author=141">Mike Winters, MBA, MD</a>
<br/>
<a href="https://umem.org/profiles/faculty/141/">Click here to contact Mike Winters, MBA, MD</a>
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<p><strong>High-Intensity NIPPV for Acute COPD Exacerbations?</strong></p>
<ul>
<li>Noninvasive positive pressure ventilation (NIPPV) is frequently used in the management of critically ill patients with an acute COPD exacerbation, and is associated with decreased intubation rates and decreased in-hospital mortality.</li>
<li>“Low” intensity NIPPV, where the inspiratory positive airway pressure (IPAP) is < 18 cm H2O, is generally used in clinical practice.</li>
<li>“High” intensity NIPPV, where the IPAP ranges from 20-30 cm H2O has recently been shown to improve gas exchange, ventilatory function, and reduced elevated PaCO2 when compared to low-intensity NIPPV.</li>
<li>The recently published HAPPEN trial was a randomized trial performed in 30 centers across China and investigated whether high-intensity NIPPV reduced the need for intubation compared with low-intensity NIPPV in patients with an acute COPD exacerbation and hypercapnia.</li>
<li>In this trial of 300 patients, investigators found that high-intensity NIPPV significantly reduced the number of patients who met criteria for intubation compared with low-intensity NIPPV.</li>
<li>Importantly, patients were included and randomized in the trial if they remained hypercapnic after initially receiving 6 hours of low-intensity NIPPV.</li>
</ul>
<h3>References</h3>
<p>Luo Z, et al. Effect of high-intensity vs low-intensity noninvasive positive pressure ventilation on the need for endotracheal intubation in patients with an acute exacerbation of chronic obstructive pulmonary disease. <em>JAMA</em>. Published online September 2024.</p>
<h3>View this pearl on the University of Maryland, Department of Emergency Medicine's website: <a href="https://umem.org/educational_pearls/4676/">https://umem.org/educational_pearls/4676/</a></h3>
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