High-Velocity Nasal Insufflation for Respiratory Failure

Dr. Jerome Martin


Dyspnea and acute respiratory failure are among the top 5 reasons for patients to present to the Emergency Department. High-velocity nasal insufflation (HVNI), a type of high-flow nasal cannula (HFNC), decreases dead space to augment ventilation in addition to providing increased oxygenation at flow rates of 25-35 L/min. Typically, HFNC is used in hypoxemic respiratory failure and noninvasive positive pressure ventilation (NIPPV) is used for hypercapnic or mixed. HVNI could be helpful in supporting both hypoxic and hypercapnic respiratory failure presenting to the ED as it does provide some ventilatory support. When compared to NIPPV it not only improves patient comfort, but has increased ease of use. 


Is there data to support the use of HVNI in undifferentiated respiratory failure? 


Doshi, P; Whittle, J; Bublewicz, M; et al. High-velocity Nasal Insufflation in the treatment of respiratory failure: A randomized clinical trial. Annals of Emergency Medicine. July 2018; 7 (1): 73-83. [paper]

Study Design

Prospective, multicenter (5 southeastern United States centers), parallel group, randomized controlled trial of two noninvasive ventilator support modalities: HVNI and NIPPV. All respiratory interventions were tracked for 72 hours after intervention. The primary outcome was treatment failure defined as endotracheal intubation and mechanical ventilation. For secondary outcomes they also looked at crossover to another study arm as a failure, as well as other biochemical, physiological, and subjective markers of respiratory status. The study used a noninferiority model to determine how HFNI compares to traditional NIPPV. 204 patients were enrolled in the trial, 104 were randomized into the HVNI group and 100 were randomized into the NIPPV group. Analysis was done in an intention to treat model.



HVNI is noninferior to NIPPV for initial treatment of undifferentiated respiratory failure.