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👉An original study conducted in China by Zujin Luo, MD, from Beijing Chao-Yang Hospital, Capital Medical University, and collaborators evaluated the effect of high-intensity vs. low-intensity NIV as respiratory support in patients with COPD exacerbation with hypercapnia in 30 respiratory care units (non-ICU) in that country.

👉 This randomized clinical trial was conducted from January 2019 to April 2022.

👉 300 patients were randomized to receive:

• High-intensity NIV with inspiratory pressure titrated to achieve a VT between 10 to 15 ml/kg of predicted body weight through an increase in IPAP.
• Low-intensity NIV with pressure titrated to a VT between 6 to 10 ml/kg of predicted body weight.

🧐 Important: patients in the low-intensity NIV group could "migrate" to the high-intensity NIV group if they met the criteria for intubation.

🧐 The primary outcome was the achievement of predefined criteria for tracheal intubation, with actual intubation being one of the secondary outcomes.

👉 In the high-intensity NIV group, 4.8% of patients met the criteria, compared to 13.7% in the low-intensity NIV group, an absolute difference of -9% (p=0.004, 95% CI -2.5% to -15.4%).

👉 Despite this, the intubation rate in both groups was similar: 3.4% (high-intensity NIV) vs. 3.9% (low-intensity NIV).

😎 See the illustrated summary in the figure below:

To access the article, click the link below.

Luo Z, Li Y, Li W, 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: The HAPPEN Randomized Clinical Trial. JAMA. They were published online on September 16, 2024. doi:10.1001/jama.2024.15815

😎 For subscribers, we will provide more details about this important study, which has the potential to influence day-to-day practice in how NIV is offered as respiratory support in COPD exacerbation.

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