High velocity nasal insufflation versus non-invasive ventilation in acute respiratory failure: a comparative study

Background
In order to treat respiratory failure, thermo-humidified nasal high flow oxygen (NHFO) therapy is being used more and more. In several clinical scenarios, NHFO has recently gained popularity as alternative noninvasive respiratory ventilation.


Aim
The aim is to assess the role of high velocity nasal insufflation (HVNI) versus noninvasive ventilation (NIV) in acute respiratory failure.


Patients and methods
This is a prospective randomized clinical study conducted on 60 patients admitted to the Chest Department at Menoufia University Hospital with acute respiratory failure. Patients were randomized to receive either noninvasive positive pressure ventilation using an oronasal mask or high-velocity nasal insufflation (initial flow was at 30-40 l/min; temperature was adjusted to 37°C; fraction of inspired oxygen 1.0) with clinical monitoring and arterial blood gas (ABG) monitoring after 2, 6, 12, and 24 h.


Results
The therapeutic impact of both, HVNI and NIV, on pressure of arterial carbon dioxide (PaCO2), hydrogen ion concentration, arterial oxygen saturation and pressure of arterial oxygen (PaO2) over time was almost similar. There was an improvement in dyspnea and a decrease in respiratory rate over time when compared with baseline results in both groups. There was no statistical difference between both groups. The failure rate in type I respiratory failure (RF) was 33.3% in the HVNI group and 28.6% in the NIV group (P-value 0.7). The failure rate in type II RF was 41.7% in the HVNI group and 25% in the NIV group (P-value 0.3). HVNI was more comfortable for patients and provided better communication and oral intake.


Conclusion
This study demonstrates that the HVNI was comparable to the NIV in the management of hypoxemic respiratory failure and could be used as a noninvasive method of ventilation alternative to the BiPAP in hypercapnic RF, with more comfortability and better communication in the HVNI group.