Is high-velocity nasal insufflation less effective than noninvasive positive-pressure ventilation in the treatment of emergency department patients with respiratory failure?

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Why is this study important?

Respiratory failure is a common emergency department (ED) presenting complaint. Several options are available for respiratory support including oxygen (O2) therapy, non-invasive positive-pressure ventilation (NIPPV), and mechanical ventilation. High-velocity nasal insufflation, the high-flow delivery of O2 by small-bore nasal cannula, induces a mild distending pressure and improves dead-space clearance of carbon dioxide (CO2). The use of nasal cannulae avoids the use of a mask and allows administration of oral and inhaled medications and potential improved comfort. This study attempts to show that high-velocity nasal insufflation is non-inferior to NIPPV for the management of undifferentiated respiratory failure.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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