HVNI vs Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure
Comparison Between HVNI vs Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure
About this trial
This is an interventional treatment trial for Comparison Between HVNI vs Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure
Eligibility Criteria
Inclusion Criteria:Participants admitted to the RICU with acute hypercapnic respiratory failure requiring NIV support with the following criteria:
- RR> 25 breath/minute.
- Use of accessory muscles of respiration, paradoxical breathing, thoracoabdominal asynchrony.
Hypoxemia evidenced by the following items:
- In patient with hypercapnic ARF:
I.Need for oxygen therapy at FIO2> 40% to maintain PaO2 > 60 mmHg or SaO2> 90% II.Blood gas analysis shows pH <7.35 and paCO2> 45 mmHg
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Exclusion Criteria:Patients with ARF who have any of the following:
I.Indication for emergency endotracheal intubation. II.HR < 50 beat\minute with decreased level of consciousness III.Persistent hemodynamic instability with
- Systolic blood pressure <90 mmHg after infusing a bolus of crystalloid solution at a dose of 30 ml / kg.
- life-threatening arrhythmia. IV.Undrained pneumothorax or Pneumothorax with persistent air leak. V.Extensive facial trauma or burnVI.Refusal to participate. VII.Usual long-term treatment with NIV for chronic disease
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
HVNI
Noninvasive ventilation
High velocity nasal insufflation (Fisher &Paykel, Auckland, New Zealan High-velocity nasal insufflation (Precision Flow;Vapotherm, Inc, Exeter, NH) (Figure 2) using a smallborenasal cannula was initiated with a flow rate set to 35 L/min, with a starting temperature between 35C and 37C and FiO2 at 1.0. Adjustments in flow (up to 40 L/min) and temperature (typically between 35C and 37C) were made to alleviate respiratory distress and optimize comfort
Respiratory assistance is provided by a NIV either Puritan Bennet 840 (Covidien, U.S.A.), EngströmCarestation (GE Healthcare, Finland) or Hamilton-G5 (Hamilton Medical, Germany), will be used for conventional non-invasive ventilation via an oronasal mask that helps patients to cope with their Breathlessness. Settings will be adjusted based on the clinical assessment of the respiratory therapist as per standard practice.