Role of high-velocity nasal insufflation in patients with acute exacerbation of interstitial lung disease

Abstract

Background
Interstitial lung diseases (ILD) are a varied group of diseases that differ in clinical presentation, course, and prognosis. Acute exacerbations of ILD can occur at any point during the disease course, increasing morbidity and mortality. High-velocity nasal insufflation (Hi-VNI) can deliver heated and humidified oxygen up to 100% at a flow rate of 40 L/min and may enhance ventilation by augmenting dead-space purge between breaths and inducing mild distending pressure.


Aim
To assess the role of Hi-VNI in providing respiratory support for ILD patients presenting with acute exacerbations and hypoxemia.


Patients and methods
A quasi-randomized, controlled parallel study was performed on 80 patients with AE-ILD; 42 patients received Hi-VNI, and 38 patients received COT. The two groups were compared regarding vital signs, arterial blood gases, laboratory findings, need for intubation, length of hospital stay, in-hospital mortality, and 30-day mortality.


Results
Treatment failure rates with Hi-VNI were lower than those with COT, with 7 patients (18.4%) on COT progressing to mechanical ventilation compared with 4 patients (9.5%) on Hi-VNI. Hospital stay was shorter in patients on Hi-VNI, with a mean of 10 days compared with 14 days for patients on COT (p-value = 0.005). In-hospital and 30-day mortality rates were lower in the Hi-VNI group, as 11 patients (28.9%) on COT died compared with 6 patients (14.3%) on Hi-VNI.
Higher APACHE II score, lower 6MWT, higher ESR, and COT usage compared to Hi-VNI were significant predictors of hospital mortality or mechanical ventilation needs, with statistically significant ORs of 1.27, 1.062, 0.237, and 47.15, respectively. Higher APACHE II score, lower 6MWT, and COT usage compared to Hi-VNI were significant predictors of 30-day mortality, with statistically significant ORs of 1.202, 0.363, and 8.465, respectively.


Conclusion
Hi-VNI therapy in patients with AE-ILD was associated with favorable clinical outcomes, including shorter hospital stay, lower rates of progression to invasive mechanical ventilation, and lower mortality. Further larger studies are needed to validate these preliminary observations. The ROX index appears to be a reliable predictor for Hi-VNI failure, whereas APACHE II score is useful in identifying patients with increased disease severity and predicting adverse outcomes.