Outcome Analysis of Noninvasive Ventilation in Acute Exacerbation of COPD Patients with Type 2 Respiratory Failure in Pulmonology Unit

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with acute exacerbations often culminating in type 2 (hypercapnic) respiratory failure. Noninvasive ventilation (NIV) has emerged as an effective therapeutic option; however, limited local data exist regarding its clinical outcomes in resource-constrained settings like Pakistan. Objective: To evaluate the effectiveness of NIV in patients with acute exacerbation of COPD presenting with type 2 respiratory failure and to examine the association of demographic and clinical factors with NIV success. Methods: A quasi-experimental study was conducted at the Pulmonology Unit of Khyber Teaching Hospital, enrolling 143 patients aged 18–80 years diagnosed with AECOPD and type 2 respiratory failure. Baseline and 6-hour post-NIV arterial blood gases (ABGs) were recorded. NIV success was defined as clinical and ABG improvement without the need for endotracheal intubation. Data were analyzed using paired t-tests and chi-square tests; a p-value <0.05 was considered statistically significant. Results: The majority of patients were male (64.3%) and between 51–70 years of age. Hypertension (55.2%), diabetes (44.8%), and smoking (67.8%) were common comorbidities. Mean pH improved from 7.26 ± 0.05 to 7.36 ± 0.04, and PaCO₂ decreased from 69.4 ± 9.8 mmHg to 59.2 ± 7.6 mmHg within six hours of NIV initiation (p < 0.001 for both). NIV was successful in 137 patients (95.8%). No statistically significant associations were found between NIV success and gender, diabetes, smoking, biomass exposure, or socioeconomic status (p > 0.05). Conclusion: Noninvasive ventilation is a highly effective intervention for managing type 2 respiratory failure in COPD patients, demonstrating rapid physiological improvement and a high success rate. Broader implementation of NIV in similar clinical settings could significantly reduce the need for invasive ventilation and its associated complications.