Efficacy of high-velocity nasal insufflation initiation in comparison to noninvasive ventilation and conventional oxygen therapy during acute respiratory failure in patients with interstitial lung disease

Background
Interstitial lung diseases (ILDs) are a varying group of diseases defined by inflammatory and fibrotic changes affecting the lung parenchyma. Respiratory failure is a common consequence in end-stage cases or after acute deterioration of the underlying disease. It can be categorized according to many factors, as the time of onset (acute or chronic), causes (reversible or irreversible), and severity (mild to severe). The cornerstone of treatment for ILDs with acute hypoxemic respiratory failure (ARF) is oxygen supplementation. There are two types of oxygen delivery systems: high-flow (also known as fixed performance) and low-flow (also known as variable performance).


Objectives
Compare traditional oxygen therapy and noninvasive ventilation to the effectiveness of early high-velocity nasal insufflation (Hi-VNI) in patients with interstitial lung disease and ARF.


Patients and methods
A total of 36 patients with known ILD and an ARF diagnosis were included in this prospective observational cohort study. They were selected from the chest department’s RICU, intermediate care unit, and ward at Ain Shams University Hospitals. The patients were categorized into three groups based on the kind of oxygen therapy they received as follows: group I included 13 patients on Conventional oxygen therapy, group II included 13 patients on (Hi-VNI) and group 3 including 10 patients on noninvasive ventilation.


Results
There were statistically significant differences in vital data, mMRC score, and FiO2 before and after usage of Hi-VNI in comparison with the twoother groups. The intubation and mortality rates were the least in Hi-VNI although statistically insignificant between the three groups.


Conclusion
Our findings revealed that Hi-VNI is more effective in acute respiratory failure in patients known with interstitial lung disease.
Significant clinical improvement of mMRC score, vital data and FiO2 after use of Hi-VNI can encourage its early application in patients with ILD and ARF.