High-intensity versus low-intensity noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (HAPPEN): study protocol for a multicenter randomized controlled trial

• Published in: Current controlled trials in cardiovascular medicine 2018-11, Vol.19 (1), p.645-645, Article 645
• Main Authors: Luo, Zujin, Wu, Chao, Li, Qi, Zhu, Jian, Pang, Baosen, Shi, Yan, Ma, Yingmin, Cao, Zhixin
• Format: Article
• Language: English
• Subjects: Airway management; Analysis; Care and treatment; China; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical trials; Disease Progression; Dyspnea; Exacerbation; High-intensity; Hospital Mortality; Humans; Hypercapnia; Hypercapnia - diagnosis; Hypercapnia - mortality; Hypercapnia - physiopathology; Hypercapnia - therapy; Informed consent; Intratracheal intubation; Intubation; Intubation, Intratracheal; Low-intensity; Lung - physiopathology; Lung diseases; Medical prognosis; Mortality; Multicenter Studies as Topic; Noninvasive positive pressure ventilation; Noninvasive Ventilation - adverse effects; Noninvasive Ventilation - methods; Noninvasive Ventilation - mortality; Patients; Positive-Pressure Respiration - adverse effects; Positive-Pressure Respiration - methods; Positive-Pressure Respiration - mortality; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Randomized Controlled Trials as Topic; Respiratory failure; Single-Blind Method; Study Protocol; Time Factors; Treatment Outcome; Ventilators
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-018-2991-y

Despite the positive outcomes of the use of noninvasive positive pressure ventilation (NPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), NPPV fails in approximately 15% of patients with AECOPD, possibly because the inspiratory pressure delivered by conventional low-intensity NPPV is insufficient to improve ventilatory status for these patients. High-intensity NPPV, a novel form that delivers high inspiratory pressure, is believed to more efficiently augment alveolar ventilation than low-intensity NPPV, and it has been shown to improve ventilatory status more than low-intensity NPPV in stable AECOPD patients. Whether the application of high-intensity NPPV has therapeutic advantages over low-intensity NPPV in patients with AECOPD remains to be determined. The high-intensity versus low-intensity NPPV in patients with AECOPD (HAPPEN) study will examine whether high-intensity NPPV is more effective for correcting hypercapnia than low-intensity NPPV, hence reducing the need for intubation and improving survival. The HAPPEN study is a multicenter, two-arm, single-blind, prospective, randomized controlled trial. In total, 600 AECOPD patients with low to moderate hypercapnic respiratory failure will be included and randomized to receive high-intensity or low-intensity NPPV, with randomization stratified by study center. The primary endpoint is NPPV failure rate, defined as the need for endotracheal intubation and invasive ventilation. Secondary endpoints include the decrement of arterial carbon dioxide tension from baseline to 2 h after randomization, in-hospital and 28-day mortality, and 90-day survival. Patients will be followed up for 90 days after randomization. The HAPPEN study will be the first randomized controlled study to investigate whether high-intensity NPPV better corrects hypercapnia and reduces the need for intubation and mortality in AECOPD patients than low-intensity NPPV. The results will help critical care physicians decide the intensity of NPPV delivery to patients with AECOPD. ClinicalTrials.gov, NCT02985918 . Registered on 7 December 2016.