High-velocity nasal insufflation versus noninvasive ventilation in managing type 1 and type 2 respiratory failure

Abstract

Background
Acute respiratory failure—hypoxemic (type I) or hypercapnic (type II)—is one of the top five causes of emergency visits. It also leads to high morbidity and mortality. Noninvasive ventilation (NIV) is the standard treatment, but high-velocity nasal insufflation (HVNI) may offer quicker setup and comparable effectiveness.


Methods
This is Prospective observational comparative cohort study conducted over one year at the Respiratory Intensive Care Unit, Chest Department, Faculty of Medicine, Cairo University. It included 58 patients admitted to the ICU due to respiratory failure (PaO₂ < 60 mmHg and/or PaCO₂ > 50 mmHg, pH < 7.35) and assigned to two groups: NIV or HVNI. Clinical monitoring involved calculating Respiratory rate, oxygenation (ROX) and Heart rate, acidosis, consciousness, oxygenation, respiratory rate (HACOR) scores, along with ABG follow-up was done. The primary objective of this study was to evaluate the clinical effectiveness of HVNI versus NIV in adults presenting with acute or acute-on-chronic respiratory failure. Secondary outcomes included treatment failure and mortality during hospitalization.


Results

In type I respiratory failure, there is no statistically significant difference between the two devices in oxygenation indicators, vital signs, or intubation rate (31.3% vs. 61.5%,
p
 = 0.103) However, the non-invasive ventilation group had a higher mortality rate (53.8% vs. 25%,
p
 = 0.111). In type II respiratory failure, there is no statistically significant difference between the two devices in oxygenation indicators, vital signs, or intubation rate (40% vs. 50%,
p
 = 0.588).



Conclusion
The high-velocity nasal insufflation device has a comparable clinical outcome to non-invasive ventilation in respiratory failure.