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Beyond NIPPV: HVNI Expands Potential Treatment Options For Acute Decompensated Heart Failure

      Thank you for this observation. Patients were chosen for the inclusion of this trial because the treating physician felt that escalation to NIPPV would be the clinically appropriate next step in the patient's care. As to the safety and efficacy in heart failure, an important exclusion criterion in the study was known or suspected myocardial infarction, to help specifically address overwhelming cardiovascular compromise. This exclusion criterion also encompassed cardiogenic shock, or other forms of shock, which were excluded as hemodynamic instability. As with any study, there was also the ability for a clinician to exclude the patient from the study based on their best clinical judgement. NIPPV is currently the standard of care in patients with ADHF when conventional oxygen delivery is not sufficient [
      • Marino P.L.
      Marino's the ICU book.
      ]. Your point that NIPPV may be harmful in certain subsets of this patient population underscores the importance of identifying alternatives to NIPPV, such as HVNI, in patients with ADHF. Patients were selected from an undifferentiated population presenting in the ED and represent a heterogeneous patient population [
      • Doshi P.
      • et al.
      High-velocity nasal insufflation in the treatment of respiratory failure: a randomized clinical trial.
      ]. These patients often had multiple pathologies, representative of a large proportion of patients seen in the ED. The authors recognize that this is a subgroup analysis resulting in interesting findings that suggest further study. We agree differentiation is an important goal - unfortunately this was a real-world study similar to what presents to the ED daily - undifferentiated patients. In subsequent trials in this population, further differentiating characterization will permit better ‘success-phenotyping’.

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      References

        • Marino P.L.
        Marino's the ICU book.
        4th ed. Lippincott Williams & Wilkins xv, 2014 ([1059 pages])
        • Doshi P.
        • et al.
        High-velocity nasal insufflation in the treatment of respiratory failure: a randomized clinical trial.
        Ann Emerg Med. 2018; 72 ([e5]): 73-83
        • Gray A.
        • et al.
        Noninvasive ventilation in acute cardiogenic pulmonary edema.
        N Engl J Med. 2008; 359: 142-151