High-Intensity NPPV Reduces Intubation Need in COPD Patients with Persistent Hypercapnia: JAMA

A new study published in the Journal of American Medical Association found that acute exacerbations of chronic obstructive pulmonary disease (COPD) may require less endotracheal intubation when high-intensity noninvasive positive pressure ventilation (NPPV) is used to treat persistent hypercapnia.

Due to the uncertainty around how high-intensity noninvasive positive pressure ventilation affects patients who have an acute exacerbation of chronic obstructive pulmonary disease in terms of the necessity for endotracheal intubation. Thus, this study by Zujin Luo and colleagues was to ascertain if endotracheal intubation is less necessary in patients facing an acute exacerbation of COPD and hypercapnia when high-intensity NPPV is used as opposed to low-intensity NPPV.

This randomized clinical study that took place in 30 general respiratory non-intensive care unit wards in Chinese hospitals between January 3, 2019, and January 31, 2022 following by a 90-day follow-up was on April 22, 2022. Following 6 hours of low-intensity NPPV, the patients included experienced an acute exacerbation of COPD and a Paco2 level higher than 45 mm Hg. In a 1:1 randomization, patients were assigned to either receive low-intensity NPPV with inspiratory positive airway pressure modified to obtain a tidal volume of 6 mL/kg to 10 mL/kg of anticipated body weight (n = 153) or high-intensity NPPV with inspiratory positive airway pressure adjusted to obtain a tidal volume of 10 mL/kg to 15 mL/kg of predicted body weight (n = 147).