Effect of High-Intensity vs Low-Intensity Noninvasive Positive Pressure Ventilation on the Need for Endotracheal Intubation in Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: The HAPPEN Randomized Clinical Trial

Methodology: 3/5
Usefulness: 3/5

Luo Z,  et al. JAMA. 2024;332(20):1709–1722. doi:10.1001/jama.2024.15815

Question and Methods: Multi-centre, randomized control trial to determine whether a high-intensity NIPPV strategy reduces the need for intubation in AECOPD patients compared to a low-intensity NIPPV strategy.
Findings: 7/147(4.8%) patients in the high-intensity compared to 21/153(13.7%) in the low-intensity group met intubation criteria; actual intubation rates were similar (high-intensity 3.4% vs. low-intensity 3.9%)
Limitations: Trial was stopped early due to effect on primary outcome and the COVID-19 pandemic; stringent inclusion/exclusion criteria; and crossover limits assessment of true effect.

Interpretation: Among AECOPD patients requiring NIPPV, starting with standard settings followed by trial of high-intensity treatment prior to intubation may be a reasonable approach in very select patients.

Dr. Nicholas Choi

JC Supervisor: Dr Thiruganasambandamoorthy

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