{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T14:30:59Z","timestamp":1789223459585,"version":"build-2803163510"},"reference-count":55,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) involve dyspnea, cough, and chest discomfort; frequent exacerbations are associated with increased mortality and reduced quality of life. Noninvasive positive pressure ventilation (NiPPV) is commonly used to help relieve symptoms but is limited due to patient intolerance. We aimed to determine whether high\u2010velocity nasal insufflation (HVNI) is noninferior to NiPPV in relieving dyspnea within 4\u2009h in ED patients with acute hypercapnic respiratory failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This randomized control trial was conducted in seven EDs in the United States. Symptomatic patients with suspected COPD, partial pressure of carbon dioxide (pCO<jats:sub>2<\/jats:sub>) \u2265\u200960\u2009mm\u2009Hg, and venous pH\u20097.0\u20137.35 were randomized to receive HVNI (<jats:italic>n<\/jats:italic>\u2009=\u200936) or NiPPV (<jats:italic>n<\/jats:italic>\u2009=\u200932). The primary outcome was dyspnea severity 4\u2009h after the initiation of study intervention, as measured by the Borg score. Secondary outcomes included vital signs, oxygen saturation, venous pCO<jats:sub>2<\/jats:sub>, venous pH, patient discomfort level, and need for endotracheal intubation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010eight patients were randomized between November 5, 2020, and May 10, 2023 (mean age 65.6\u2009years; 47% women). The initial pCO<jats:sub>2<\/jats:sub> was 77.7\u2009\u00b1\u200913.6\u2009mm\u2009Hg versus 76.5\u2009\u00b1\u200913.6\u2009mm\u2009Hg and the initial venous pH was 7.27\u2009\u00b1\u20090.063 versus 7.27\u2009\u00b1\u20090.043 in the HVNI and NiPPV groups, respectively. Dyspnea was similar in the HVNI and NiPPV groups at baseline (dyspnea scale score 5.4\u2009\u00b1\u20092.93 and 5.6\u2009\u00b1\u20092.41) and HVNI was noninferior to NiPPV at the following time points: 30\u2009min (3.97\u2009\u00b1\u20092.82 and 4.54\u2009\u00b1\u20091.65, <jats:italic>p<\/jats:italic>\u2009=\u20090.006), 60\u2009min (3.09\u2009\u00b1\u20092.70 and 4.07\u2009\u00b1\u20091.77, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and 4\u2009h (3.17\u2009\u00b1\u20092.59 and 3.34\u2009\u00b1\u20092.04, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). At 4\u2009h, there was no difference between the groups in the pCO<jats:sub>2<\/jats:sub> mm\u2009Hg (68.76 and 67.29, <jats:italic>p<\/jats:italic>\u2009=\u20090.63). Patients reported better overall comfort levels in the HVNI group at 30\u2009min, 60\u2009min, and 4\u2009h (<jats:italic>p<\/jats:italic>\u2009=\u20090.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In participants with symptomatic COPD, HVNI was noninferior to NiPPV in relieving dyspnea 4\u2009h after therapy initiation. HVNI may be a reasonable treatment option for some patients experiencing moderate acute exacerbations of COPD in the ED.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.15038","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T05:24:28Z","timestamp":1733981068000},"page":"403-413","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["High\u2010velocity nasal insufflation versus noninvasive positive pressure ventilation for moderate acute exacerbation of chronic obstructive pulmonary disease in the emergency department: A randomized clinical trial"],"prefix":"10.1111","volume":"32","author":[{"given":"David P.","family":"Yamane","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine George Washington University School of Medicine and Health Sciences  Washington DC USA"},{"name":"Department of Anesthesia and Critical Care Medicine George Washington University School of Medicine and Health Sciences  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9704-9094","authenticated-orcid":false,"given":"Christopher W.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Cooper University Healthcare  Camden New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Gentry","family":"Wilkerson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua J.","family":"Oliver","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Madigan Army Medical Center, Joint Base Lewis\u2010McChord  Tacoma Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soroush","family":"Shahamatdar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine George Washington University School of Medicine and Health Sciences  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Loganathan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine George Washington University School of Medicine and Health Sciences  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Bolden","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine George Washington University School of Medicine and Health Sciences  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Heidish","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine George Washington University School of Medicine and Health Sciences  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor L.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Madigan Army Medical Center, Joint Base Lewis\u2010McChord  Tacoma Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Bergeski","sequence":"additional","affiliation":[{"name":"Vapotherm, Inc.  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