Comparison of High-flow Oxygen vs. BiPAP in Type II (Hypercapnic) Respiratory Failure

We will compare various clinically relevant outcomes in patients treated for type II (hypercapnic) acute respiratory failure (ARF) with either High-Flow Nasal Cannula (HFNC) or Non-Invasive Ventilation (NIV) in a general adult hospital.

All patients treated with HFNC were treated with an Optiflow device (Fisher\&Paykel). Various Bilevel positive airway pressure (BiPAP) devices were used during the study period.

All ventilatory parameters were set according to the treating physicians' preferences.

• Non-Invasive Ventilation (Device), also known as BiPAP: Treatment with Non-Invasive Ventilation by BiPAP. Different BiPAP models are in use. Ventilation parameters set at the discretion of the treating physician.
• High-Flow Nasal Cannula (Device), also known as HFNC: Treatment with a High-Flow Nasal Cannula. The Optiflow device by Fisher\&Paykel used in all cases. Flow and fraction of inspired oxygen (FiO2) parameters at the discretion of the treating physician.

Primary outcomes

• Failure of initial treatment (combined outcome) [48 hours post intervention]: Combined outcome of death or intubation or transition to another treatment modality or unplanned resumption of respiratory support
• Death at 48h [48 hours post intervention]: Mortality in the 48h following the initial intervention

Secondary outcomes

• Mortality at 7d [7 days post intervention]: Incidence of death in the 7 days after intervention
• Incidence of endotracheal intubation [For the whole length of hospital stay, up to a maximum of one year.]: The incidence of intubation
• Length of stay [For the whole length of hospital stay, up to a maximum of one year.]: Duration of stay in the hospital, in days
• Duration of endotracheal intubation [For the whole length of hospital stay, up to a maximum of one year.]: Duration (in hours) of the first episode of endotracheal intubation, immediately following the failed intervention
• Incidence of intervention change [For the whole length of hospital stay, up to a maximum of one year.]: The incidence of patients who switch from Non-Invasive Ventilation to High-Flow Oxygen, and vice versa, due to treatment failure

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* All patients treated with respiratory failure not responding to conventional supplemental oxygen therapy
* Blood venous gas showing partial pressure of carbon dioxide>50 mmHg before beginning therapy with either NIV or HFNC

Exclusion Criteria:

* Lack of records of the primary outcome
* End-of-life care
* Lack of gas before the beginning of NIV or HFNC

• Ivan Pavlov, MD, Principal investigator, Ivan Pavlov MD CP inc