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Updated: Feb 23, 2026

Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
High Intensity Non-Invasive Positive Pressure Ventilation (HINPPV) for Stable Hypercapnic Chronic Obstructive
Mark Weir1, Nathaniel Marchetti1, Aaron Czysz1
1Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
Abstract:
Introduction: High intensity non-invasive positive pressure ventilation (HI-NPPV) is an algorithm of non-invasive ventilation that has been shown to improve partial pressure of carbon dioxide (PaCO2), health-related quality of life and mortality in hypercapnic chronic obstructive pulmonary disease (COPD) patients. Objective: Assess 3 months of HI-NPPV in stable hypercapnic COPD patients. Methods: A single arm, non-randomized pilot study of HI-NPPV. Patients were eligible if they had clinically stable COPD and daytime arterial PaCO2 >50 mmHg. Results: Nine patients completed therapy. Patient characteristics: 2 male: 7 female, mean age of 64.4 years (SD ±6.6), mean forced expiratory volume in 1 second (FEV1) of 26% (SD±6.73), 8 patients on long term oxygen therapy (LTOT) and a median body mass index (BMI) of 26.6 (interquartile range [IQR] 25.5 - 32.5). Outcomes: There was a mean reduction in daytime PaCO2 by 4.66 mmHg (p=0.01) and bicarbonate by 2.16 mmHg (p=0.005). There was no statistically significant difference in lung function, maximal inspiratory pressures or 6 minute walk distance. There was no statistically significant difference in sleep duration, efficiency or percentage of sleep stage 3 ( N3) or rapid eye movement (REM). The Chronic Respiratory Questionnaire (CRQ) showed a trend towards improvement with an increase of 2.69 points (p=0.054), the dyspnea domain showed a statistically significant improvement (p=0.03). The Calgary Sleep Apnea Quality of Life Index (SAQLI) detected an improvement in daily functioning (p=0.007). The Severe Respiratory Insufficiency (SRI) Questionnaire showed a trend to improvement overall (p=0.05). Four patients had COPD exacerbations during the follow up period. Conclusions: HI-NPPV is able to substantially reduce PaCO2 in hypercapnic COPD patients; we detected a positive effect on quality of life measures with no significant change in sleep quality.
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