Outcome of Non-Invasive Ventilation and Its Predictors in COPD Patients with Acute or Acute On Chronic Type 2 Respiratory Failure

Abstract

Background: Noninvasive ventilation (NIV) constitutes a primary therapeutic modality in the management of chronic obstructive pulmonary disease (COPD) patients presenting with acute or acute-on-chronic type 2 respiratory failure [1,4–6]. Despite its clinical utility, considerable variability in patient outcomes persists, and the early identification of reliable predictors of NIV success or failure remains a significant clinical challenge [7,13,14].

Objective: To evaluate the outcomes of noninvasive ventilation and identify clinical and biochemical predictors of its success or failure in patients with chronic obstructive pulmonary disease (COPD) presenting with acute or acute-on-chronic type 2 respiratory failure.

Methods: A prospective observational study was conducted on 85 patients with chronic obstructive pulmonary disease (COPD) presenting with acute or acute-on-chronic type 2 respiratory failure, admitted between May 2023 and May 2024. All patients were initiated on noninvasive ventilation (NIV) as per institutional protocol [4,6,9]. Baseline clinical parameters, arterial blood gas values, and comorbidities were recorded. Patients were monitored throughout the course of NIV therapy, and outcomes were classified as success (clinical improvement without need for intubation) or failure (requirement of invasive mechanical ventilation or death). Statistical analysis was performed to identify clinical and biochemical predictors associated with NIV outcomes [7,13,14]. Results: Among the 85 COPD patients included in the study, NIV was successful in 65 patients (76.5%) and failed in 20 patients (23.5%). Patients in the failure group had significantly lower baseline pH and PaO₂ levels, and higher PaCO₂ and respiratory rates compared to those in the success group (p < 0.05). PaCO2 at 12, 24, 48, 72 hrs in NIV success are 52.04±2.93, 49.63±2.89, 44.78±4.31, 43.22±5.20 and in NIV failure are 54.78±2.33, 54.89±1.83, 54.44±1.27, 55.44±1.33, respectively with a significant P value.

Conclusion: Noninvasive ventilation was effective in the majority of COPD patients with acute or acute-on-chronic type 2 respiratory failure [4–6,9,12]. Higher baseline PaCO₂ and respiratory rate, along with lower pH, were significantly associated with NIV failure [13,14]. Early identification of these predictors may aid in timely clinical decision-making and improve patient outcomes.