Here is a quick wee of our hot take on the HAPPEN Trial on NIPPV for Acute Exac. of COPD. I got Josh Farkas and Alex Bracey to discuss
The Trial
Happen Trial
What was the Criteria for Intubation
The primary outcome was the need for endotracheal intubation during hospitalization, which was defined by the prespecified criteria of (1) arterial pH level of less than 7.25 with a Paco2 level that increased by more than 20% compared with the baseline level or Pao2:Fio2 of less than 100 mm Hg; and (2) the presence of at least 1 of the following: clinical signs suggestive of severely decreased consciousness (eg, coma, delirium), use of accessory respiratory muscles or thoracoabdominal paradoxical movement, excessive respiratory secretions, aspiration or vomiting, bleeding in upper gastrointestinal tract, severe hemodynamic instability without response to fluid resuscitation and low-dose vasoactive agents, or ventricular or supraventricular arrhythmias; or (3) cardiac or respiratory arrest. Daily assessment of the need for endotracheal intubation was performed. Two independent experts who were blinded to the intervention confirmed the need for endotracheal intubation based on these criteria. In cases of disagreement, a third expert helped make the final decision.
What are your thoughts–put them in the comments section below…
Additional Study Mentioned re: 6 ml vs. 10 ml
Now on to the Wee…
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Hi Guys,
I really enjoyed that discussion. What masks are each of you using for your NIV patients, and do you find a difference between the full face masks versus the masks covering the nose and mouth in terms of fit/comfort?
still using just nose/mouth–do not have access to helmet or full face