High-intensity noninvasive ventilation significantly reduced the likelihood of meeting intubation criteria in patients with chronic obstructive pulmonary disease compared with low-intensity ventilation, though actual intubation rates remained unchanged, according to a recent study. 

In the randomized clinical High-intensity vs Low-intensity Noninvasive Positive Pressure Ventilation in an AECOPD study, published in JAMA, researchers investigated whether high-intensity noninvasive positive pressure ventilation (NPPV) could reduce the need for endotracheal intubation in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) compared with low-intensity NPPV. Conducted across 30 hospitals in China from January 2019 to January 2022, the researchers enrolled 300 patients who were initially treated with 6 hours of low-intensity NPPV before being randomly assigned to either continue low-intensity NPPV or switch to high-intensity NPPV.

The researchers found that 4.8% of the patients in the high-intensity NPPV group met the prespecified criteria for endotracheal intubation compared with 13.7% of the patients in the low-intensity NPPV group (absolute difference = −9.0%, 95% confidence interval = −15.4% to −2.5%, P = .004). However, the actual intubation rates did not significantly differ between the high-intensity and low-intensity groups (3.4% vs 3.9%, P = .81). The patients in the low-intensity group who met criteria for intubation were allowed to cross over to the high-intensity NPPV group, which may have affected overall intubation rates. Abdominal distension was more frequent in the high-intensity group (37.4% vs 25.5%), with no notable differences in other adverse events.

Given the lack of a significant difference in actual intubation rates, the clinical benefits of high-intensity NPPV in this patient population remain unclear.

The authors reported no conflicts of interest related to this study.