The ventilatory effect of High Velocity Nasal Insufflation versus Non-invasive Positive Pressure Ventilation in the treatment of acute hypercapnic respiratory failure in patients with AECOPD

Background:High-Velocity Nasal Insufflation (Hi-VNI) is a type of non-invasive ventilation (NIV) that doesn't require a face mask and is used to help oxygenate patients experiencing respiratory distress.At flow rates of 35 liters per minute,it can completely clear extrathoracic dead space,besides oxygenation support.It may also be able to provide ventilatory assistance in patients suffering from acute type II respiratory failure.This study evaluated the ventilatory support capabilities of Hi-VNI.Patients and methods:Seventy-four AECOPD patients presented to Cardiothoracic Minia University Hospital during the period from November 2022 to January 2024 by acute hypercapnic respiratory failure were enrolled in this study.Cases were divided into two categories based on the first line of ventilatory support used,including NIPPV group (40 patients) and Hi-VNI group (34 patients).Results:34 of the 74 included patients were randomized to Hi-VNI and 40 patients to NIPPV and both groups were compared regarding the ventilatory effect of the used regimen.The therapeutic impact on Respiratory Rate (RR),hydrogen ion concentration (pH),partial pressure of carbon dioxide in arterial blood (PaCO2) and partial pressure of arterial oxygen (PaO2) over time in every group were similar.The intubation rate was17.6% in the Hi-VNI group and 25% in the NIPPV group (p value = 0.244).The percentage of patients who do not improve after treatment was 35.3% in the Hi-VNI group and 32.5% in the NIPPV group (p value = 1.0).Conclusion:Hi-VNI may provide ventilatory support similar to NIPPV in COPD patients presenting with acute type II respiratory failure. More research is required to confirm these results.