High-Intensity NIPPV for Acute COPD Exacerbations?
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.
“Low” intensity NIPPV, where the inspiratory positive airway pressure (IPAP) is < 18 cm H2O, is generally used in clinical practice.
“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.
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.
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.
Importantly, patients were included and randomized in the trial if they remained hypercapnic after initially receiving 6 hours of low-intensity NIPPV.
References
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. JAMA. Published online September 2024.
