Ventilation In Acute Exacerbation Research Articles

A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease

PurposeWe investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations. MethodsThis prospective, randomized, single-blind study assigned patients to one of three study groups. The NIV group (n = 47) received bilevel positive airway pressure. The HFNC-30 (n = 44) and HFNC-50 (n = 46) groups received HFNC therapy at flow rates of 30 and 50 L/min, respectively. Demographic and clinical characteristics and arterial blood gas parameters before and 30, 60, and 120 min after treatment were compared among the treatment groups. ResultsThis study included 137 consecutive patients with acute exacerbations of COPD, comprising 90 males and 47 females, with a mean age of 68.1 ± 10.5 years. A total of 21 patients (15.33 %) were intubated, and the overall mortality rate was 10.2 %. The mean PaCO2 levels on admission were 64.69 ± 10.81, 61.51 ± 9.03, and 62.29 ± 9.87 in the NIV, HFNC-30, and HFNC-50 groups, respectively, with no significant differences observed (p = 0.372). A significant reduction in mean PaCO2 was observed in all treatment groups at 30, 60, and 120 min (p < 0.05 for all). However, the ΔPaCO2 at 60 min was significantly higher in the HFNC-30 group compared to the NIV group (p = 0.042). Additionally, neither intubation rates nor 28-day mortality differed among the treatment groups (p = 0.368 and p = 0.775, respectively). ConclusionHFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO2 in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO2 levels at 60 min. Trial RegistryNational Library of Medicine Clinical Trial Registry; No.: NCT06495086; URL: https://clinicaltrials.gov/study/NCT06495086

Developing an Evidence-Based Interprofessional Algorithm to Apply Noninvasive Ventilation in Acute Exacerbation of COPD

When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to COPD exacerbation in conjunction with guideline-recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Prior studies suggest that efforts to increase NIV use in acute exacerbation of COPD (AECOPD) need to account for the complex and interprofessional nature of NIV delivery and the need for interprofessional team coordination. We sought to develop an evidence-based interprofessional algorithm to apply NIV in AECOPD to improve the appropriate utilization of NIV in AECOPD. In this prospective qualitative descriptive study, subject matter expert physicians, nurses, and respiratory therapists practicing in a variety of clinical settings caring for patients with AECOPD were recruited for semistructured interviews. The Consolidated Criteria for Reporting Qualitative Research checklist was followed for interview development. Interview themes applicable to interprofessional collaborative practice were identified using deductive thematic analysis. An NIV algorithm based on recent society guidelines was constructed. Interprofessional team tasks appropriate for each phase of the NIV process were integrated into the algorithm. We present an interprofessional team-based algorithm for delivery of NIV in AECOPD inclusive of patient selection and initiation, titration, monitoring, and weaning of NIV. The goal is to increase appropriate uptake of NIV in the AECOPD population. The identified roles and responsibilities of an interprofessional team could be integrated into an interprofessional education program pertaining to use and management of NIV for patients with AECOPD emphasizing collaborative best practice, interprofessional team communication, and support of professional autonomy when appropriate.

High-Flow Nasal Oxygen versus Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Meta-Analysis of Randomized Controlled Trials.

High-flow nasal cannula (HFNC) can be used in stable chronic obstructive pulmonary disease (COPD) patients, but the effect of HFNC on clinical outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still uncertain. We searched electronic literature databases for randomized controlled trials (RCTs) comparing HFNC with noninvasive ventilation (NIV) in hypercapnic patients with AECOPD. The primary endpoint of this meta-analysis was PaCO2, PaO2, and SpO2. The secondary outcomes were the respiratory rate, mortality, complications, and intubation rate. We included 7 RCTs with a total of 481 patients. There were no significant differences on measures of PaCO2 (MD = -0.42, 95%CI -3.60 to 2.75, Z = 0.26, and P = 0.79), PaO2 (MD = -1.36, 95%CI -4.69 to 1.97, Z = 0.80, and P = 0.42), and SpO2 (MD = -0.78, 95%CI -1.67 to 0.11, Z = 1.72, P = 0.08) between the HFNC group and the NIV group. There was no significant difference in measures of the mortality and intubation rate between the HFNC group (OR = 0.72, 95%CI 0.30 to 1.69, Z = 0.76, and P = 0.44) and the NIV group (OR = 2.38, 95%CI 0.49 to 11.50, Z = 1.08, and P = 0.28), respectively. But the respiratory rate in the HFNC group was lower than that in the NIV group (MD = -1.13, 95%CI -2.13 to -0.14, Z = 2.23, and P = 0.03), and fewer complications were found in the HFNC group (OR = 0.26, 95%CI 0.14 to 0.47, Z = 4.46, and P < 0.00001). NIV was noninferior to HFNC in decreasing PaCO2 and increasing PaO2 and SpO2. Similarly, the mortality and intubation rate was similar among the two groups. The respiratory rate and complications were inferior in the AECOPD group treated with HFNC.

Noninvasive ventilation in acute exacerbation of interstitial lung diseases

Introduction Noninvasive ventilation (NIV) has been recognized as a mean to avoid intubation and to reduce the risk of complications. Aims To study the role of NIV in acute respiratory failure in patients with interstitial lung diseases (ILD). Settings and design This was a prospective study. Patients and methods The present study included 30 mechanically ventilated patients through noninvasive masks subjected basically to informed consent, clinical data collection, laboratory investigations, chest radiograph, and arterial blood gas samples. Results A total of 20 patients were found to be survivors, whereas 10 patients were found to be nonsurvivors. The most common type of ILD in our study was hypersensitivity pneumonitis (53.3% of all patients) with fibrosis, and ground glass opacities were the most common radiological findings on high-resolution computed tomography, and moderate restrictive pattern in pulmonary function tests. Infection was the main cause of exacerbation as evidenced by fever, elevated total leukocytic count, staff neutrophilic count, and erythrocyte sedimentation rate. None of our patients developed complications or intolerance to NIV. Conclusion There was improvement in oxygenation parameters, so NIV could be a valuable option for management of acute type I mild to moderate respiratory failure in patients with ILD.

Diaphragmatic impairment as a predictor of invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease patients

ABSTRACT Objective Study the impact of ultrasound-assessed diaphragmatic impairment (DI) on predicting need for invasive mechanical ventilation (IMV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients treated by non-invasive ventilation (NIV). Design A prospective observational study. Setting Critical Care Units of Alexandria Main University Hospital. Patients 75 adult AECOPD patients of both sexes according to sample size calculation. Methods Ultrasound was used to measure diaphragmatic thickness (DT), diaphragmatic thickness fraction (DTF) was calculated, and DI was diagnosed when fraction was less than 20%. Patients were treated by NIV. Switching to IMV was done after NIV failure. Primary outcome was value of DI to predict need for IMV after NIV failure. Secondary outcome was impact of DI on fate of patients. Results According to fate of NIV, patients were categorized into successful and failed NIV groups. DTF in both groups were ≥33–38% and ≤16–18%. DTF with a cut-off value of <26–29% on both sides was able to predict NIV failure with 96.67% sensitivity and 80–82.22% specificity. Days of MV and ICU stay were significantly lower in the successful NIV group, p < 0.001. 28-day mortality was significantly less encountered in successful NIV group, p = 0.018. Conclusion DTF was a good indicator of DI that could predict need for IMV after NIV failure in AECOPD patients with good sensitivity and moderate specificity. MV Days, ICU stay, and 28-day mortality were significantly higher in patients with DI who needed IMV.

Is PM2.5 associated with emergency department visits for mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease?

Patients with chronic obstructive pulmonary disease (COPD) can have recurrent exacerbations and acute respiratory failure (ARF) triggered by particulate matter with a diameter of ≤2.5μm (PM2.5). To prevent ventilator shortages, this study investigated the short-term association between PM2.5 concentration and emergency department visits (EDVs) among patients with acute exacerbation of COPD (AECOPD) requiring mechanical ventilation (MV). We conducted a time-series study to predict the PM2.5 concentration and number of ventilators needed. Daily counts of EDVs among AECOPD patients requiring ventilation from 2015 to 2019 were obtained from a hospital. Generalized linear models extending Poisson regression were used to explore the association of AECOPD with PM2.5 after controlling for the time trend, seasonal variations, and meteorological variables. Eight hundred seventy-five AECOPD patients receiving MV were recorded, of whom 734 received noninvasive ventilation and 141 received invasive ventilatory support. EDVs for AECOPD patients with ARF significantly increased by 3.5% (95% confidence interval [CI]: 2.51%-4.42%) per 10μgm-3 increase in PM2.5 concentration. Among seasons, PM2.5 concentration had the strongest effect on AECOPD patients with ARF in spring (<24.5°C), with a 1.64% (95% CI: -0.56% to 3.83%) increase in admissions per 10μgm-3 increase in same-day PM2.5 concentration. The interquartile range increase of 20μgm-3 between winter and spring was associated with an average EDV increase of 48.66%. This is the first study to predict the number of ventilators required by calculating quantitative estimates of the short-term effects of PM2.5 on EDVs for AECOPD patients with ARF. Adverse effects of PM2.5 on AECOPD patients requiring MV are evident, especially in the spring. Establishing protective standards and reducing the PM2.5 concentration to below various thresholds are urgently needed.

Noninvasive ventilation in acute exacerbation of COPD: Homer is close to shore

Noninvasive ventilation in acute exacerbation of COPD: Homer is close to shore

Non-invasive ventilation in acute exacerbation of COPD with mild to moderate type 2 respiratory failure

Chronic obstructive pulmonary disease is a syndrome of progressive airflow limitation caused by abnormal inflammatory reaction of airway and lung parenchyma. Risk factor for development of COPD is a complex interaction of genetic factors and many environmental exposures, with the cigarette smoking being the most common etiological agent.It is a prospective observational comparative study conducted among patient with mild to moderate type 2 respiratory failure, secondary to acute exacerbation of Chronic Obstructive Pulmonary Disease admitted in chest ward department of Respiratory medicine, Late Shri Lakhi Ram Agrawal Memorial Medical College, Raigarh, Chhattisgarh, India for a period of one year from April 2020- April 2021.A total 60 patients were studied. Out of which, 30 patients in study group for whom non-invasive ventilation support along with conventional treatment was given and remaining 30 patients in comparison group, same treatment was given without non-invasive ventilation support. Both groups had similar demographic, clinical, biochemical profile at the time of admission. Distribution of comorbidities, smoking history were similar as shown below in tables. After application of Non-invasive ventilation along with conventional treatment in study group, the result showed that mean hours of NIV use in study group was 27 hours and mean hours of Oxygen use in comparison group was 98 hours.Use of non-invasive ventilation in acute exacerbation of COPD, with mild to moderate type 2 respiratory failure, reduced tachypnoea, tachycardia, after 4 hours. There were improvement in oxygen saturation after 4 hours, improvement in PH also occurred after 4 hours by 0.04. Non-invasive ventilation gives rest to fatigued inspiratory muscle so work of breathing is reduced. It also restores functional and biochemical changes associated with fatigued muscle so all complication were reduced with use of non- invasive ventilation.

Comparison of Vibrating Mesh and Jet Nebulizers During Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Background: Advances in aerosol technology have improved drug delivery efficiency during noninvasive ventilation (NIV). Clinical evaluation of the efficacy of aerosol therapy during NIV in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) is very limited. The aim of our study was to compare the efficacy of bronchodilators administered through a vibrating mesh nebulizer (VMN) and jet nebulizer (JN) during NIV in patients with acute exacerbation of COPD. Methods: Prospective randomized cross-over study included 30 patients treated with NIV for acute exacerbation of COPD in an acute care hospital. Patients were consented and enrolled after stabilization of acute exacerbation (3-5 days after admission). Subjects were randomly assigned into two treatment arms receiving salbutamol (2.5 mg): with VMN (Aerogen Solo) and JN (Sidestream) positioned between the leak port and the nonvented oronasal mask during bilevel ventilation with a single-limb circuit. Measurements (clinical data, pulmonary function tests [PFTs], and arterial blood gases) were performed at baseline, 1, and 2 hours after treatment. Results: All measured PFT parameters significantly increased in both groups, but numerically results were better after inhalation with VMN than with JN: for forced expiratory volume in 1 second (FEV1) (mean increase from baseline to 120 minutes-165 ± 64 mL vs. 116 ± 46 mL, p = 0.001) and for forced vital capacity (FVC) (mean increase-394 ± 154 mL vs. 123 ± 57 mL, p < 0.001). There was also a statistically significant reduction in respiratory rate and in Borg dyspnea score after therapy with VMN in comparison with the conventional JN. In both groups, there were improvements in PaCO2, but with VMN these changes were significantly higher. Conclusion: Bronchodilator administration in patients with acute exacerbation of COPD during NIV with VMN resulted in clinically significant improvements in FVC and in Borg dyspnea score. Additional studies required to determine the impact on clinical outcomes.

Nasal high-flow oxygen versus noninvasive ventilation in acute exacerbation of COPD: protocol for a randomised noninferiority clinical trial.

BackgroundNoninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it.AimThe study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure.MethodsWe designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and PaCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain SpO2 between 88%–92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death.ConclusionGiven the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.

Patients with interstitial lung disease and pulmonary sarcoidosis are at high risk for severe illness related to COVID-19.

Analyses of COVID-19 patients with preexisting interstitial lung disease (ILD) or pulmonary sarcoidosis is lacking but registries are ongoing. Treatment of COVID-19 in patients with underlying ILD or sarcoidosis may include hospital admission, possible drug treatment, caution with steroids, and avoidance of mechanical ventilation in acute exacerbation of ILD. Patients with COVID-19 respiratory illness are at risk for developing ILD.

Non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease: Results from an anonymous survey of physicians

Non-invasive ventilation (NIV) is an evidence-based treatment modality for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF). It has been shown to reduce mortality, in-hospital complications, length of stay and is cost effective compared to invasive ventilation. Despite this, data from UK has shown higher mortality and a wide variation in practice in the use of NIV in AHRF. …

Non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease: pressure support versus volume assured pressure support

Non-invasive ventilation in acute exacerbation of chronic obstructive pulmonary disease: pressure support versus volume assured pressure support

A Randomized Controlled Trial of Noninvasive Ventilation with Pressure Support Ventilation and Adaptive Support Ventilation in Acute Exacerbation of COPD: A Feasibility Study

Whether the use of adaptive support ventilation (ASV) during noninvasive ventilation (NIV) is as effective as pressure support ventilation (PSV) remains unknown. In this exploratory study, we compared the delivery of NIV with PSV vs. ASV. We randomized consecutive subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) to receive NIV either with the PSV or the ASV mode. The primary outcome was NIV failure (endotracheal intubation, re-institution of NIV within 48 h of discontinuation or mortality). The secondary outcomes were the duration of mechanical ventilation (invasive and noninvasive), the number of NIV manipulations, the visual analogue score (VAS) for physician’s ease of use and patient’s comfort, and the complications of NIV use. We enrolled 74 subjects (n = 38, PSV; n = 36, ASV; 78.4% males) with a mean (SD) age of 60.5 (9.5) years. The baseline characteristics were similar between the two groups. The overall NIV failure rate was 28.4% and was similar between the two groups (PSV vs. ASV: 34.2% vs. 22.2%, p = 0.31). There was a 9% reduction in the intubation rate with ASV. There were six deaths (PSV vs. ASV: 2 vs 4, p =0.311). There was no difference in the secondary outcomes. The application of NIV using ASV was associated with a similar success rate as PSV in subjects with AECOPD. Due to the small sample size, the results of our study should be confirmed in a larger trial.Trial registry: ww.clinicaltrials.gov (NCT02877524).

Effect of neurally adjusted ventilatory assist on trigger of mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease patients with intrinsic positive end-expiratory pressure

Objective: To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods: AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH(2)O (1 cmH(2)O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode. Servo Tracker software continuously recorded the waveform of ventilator and respiratory mechanics indexes (including respiratory frequency, inspiratory tidal volume (Vti), minute ventilation volume (VE), peak airway pressure (PIP), inspiratory time), and calculated trigger and expiratory conversion delay time, work of trigger and total work of breath. Results: A total of 14 AECOPD patients were enrolled with the average PEEPi (4.3±1.3) cmH(2)O. PSV inspiratory trigger delay time was positively correlated with PEEPi (r=0.913, P<0.05). Compared with PSV, NAVA significantly decreased trigger delay time in low, medium and high pressure level groups [(48±17) ms vs. (167±86) ms, (63±65) ms vs. (247±240) ms, (63±49) ms vs. (342±192) ms,respectively all P<0.05]. Similar results were shown as to work of trigger [(0.92±0.36) μV∙s vs. (1.22±0.70) μV∙s, (1.08±0.51) μV∙s vs. (1.62±1.25) μV∙s, (1.20±0.96) μV∙s vs. (2.29±1.02) μV∙s, all P<0.05]. Trigger delay time increased according to the increase of pressure level in PSV mode. Conclusion: The presence of PEEPi in AECOPD patients leads to obvious trigger delay under PSV mode, which is positively correlated with PEEPi level. NAVA significantly reduces trigger delay time and work of trigger compared with PSV mode.

Ward-Based Non-Invasive Ventilation in Acute Exacerbations of COPD: A Narrative Review of Current Practice and Outcomes in the UK.

Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK.

Outcomes and predictors of success of noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease

BackgroundNoninvasive ventilation is appropriately used as a first-line treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in many emergency departments. It has been evaluated in a large number of trials, often with clinically important benefits, but the use of noninvasive positive pressure ventilation remains highly variable across institutions and geographical regions. The aim of the study was first to emphasize the superiority of noninvasive ventilation (NIV) in acute hypercapneic respiratory failure in patients with an AECOPD in comparison with conventional therapy alone and second was to identify the predictors of NIV failure in such patients.Patientsand methods A total of 50 patients were randomly allocated into two equal groups: 25 patients subjected to medical and oxygen therapy (group I) and 25 to medical and NIV (group II). All patients were followed until death or discharge.ResultsGroup II had a success rate (for weaning and discharge) of 76%, whereas in group I, it was 20% (odds ratio=0.0789, 95% confidence interval=0.021–0.302 and P<0.001). Hospital stay was significantly longer in group I. Complications were significantly higher in group I. Mortality was significantly higher in group I. Improvement of arterial blood gases, respiratory rate, dyspnea scores and hypercarbic encephalopathy was significantly better in non-invasive positive pressure ventilation (NIPPV) group.ConclusionThe addition of NIPPV to standard therapy confers more benefits in patients with AECOPD, with significant reduction of in-hospital mortality, rate of endotracheal intubation, incidence of complications and length of hospital stay compared with standard therapy alone. On the contrary, failure can be predicted by the presence of more comorbidities, signs of severe exacerbation, high BMI, high baseline blood sugar, rapid respiratory rate at admission, abnormal baseline renal functions, high baseline C-reactive protein, high baseline acute physiology and chronic health evaluation II and BAP 65: B=BUN; A=Altered mental status; P=Pulse rate; 65-age years (BAP 65) scores, severe acidosis before NIV treatment and persistent severe acidosis after 1 h of treatment.

A Prospective, Randomized Controlled Trial of Noninvasive Ventilation in Acute Exacerbation of Asthma in Children

A Prospective, Randomized Controlled Trial of Noninvasive Ventilation in Acute Exacerbation of Asthma in Children

Comparative Study of Adaptive Support Ventilation vs Synchronized Intermittent Mandatory Ventilation in Acute Exacerbation of COPD Patients

Comparative Study of Adaptive Support Ventilation vs Synchronized Intermittent Mandatory Ventilation in Acute Exacerbation of COPD Patients

Trends in assisted ventilation and outcome for obstructive pulmonary disease exacerbations. A nationwide study.

BackgroundNon-invasive ventilation (NIV) has been used for decades in treatment of exacerbations of chronic obstructive pulmonary disease (COPD). The impact of the changing use of assisted ventilation in acute exacerbations on outcomes has not been fully elucidated and we aimed to describe these changes in the Danish population and describe their consequences for mortality.MethodsA register-based study was conducted of a cohort of 12,847 patients admitted for acute exacerbation of COPD (AECOPD) from 2004 through 2011, treated with invasive mechanical ventilation (IMV) or NIV for the first time. Age, sex, in-hospital mortality rates, time to death or readmission for AECOPD were established and changes over time tracked.ResultsThe number of admissions for AECOPD where assisted ventilation was used was 1,130 in 2004 and had increased by 145% in 2011. First time ventilations increased by 88%. This was mainly due to an increase in use of NIV accounting for 36% of the total number of assisted ventilations in 2004 and 67% in 2011. The number of IMV with or without NIV treatments remained constant. The mean age of NIV patients increased from 71.5 to 73.6 years, but remained constant at 70.0 years in IMV patients. Mortality rates both in hospital and after discharge for patients receiving NIV remained constant throughout the period. In-hospital mortality following IMV increased from 30% to 38%, but mortality after discharge remained stable.ConclusionAssisted ventilation has been increasingly used in a broader spectrum of AECOPD patients since the introduction of NIV. The changes in treatment strategies have been followed by shifts in in-hospital mortality rates following IMV.