The Role of Non-Invasive Ventilation in Acute Exacerbations of COPD in the Emergency Setting: A Review of Outcomes and Best Practices

Abstract

Non-invasive ventilation (NIV) is a first-line intervention for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) complicated by hypercapnic respiratory failure in the emergency department (ED). This review synthesizes evidence demonstrating that NIV significantly reduces short-term mortality, decreases intubation rates by approximately 60%, and shortens hospital length of stay compared to standard oxygen therapy. Its efficacy hinges on correcting respiratory acidosis and reducing the work of breathing. Success is maximized by rapid, protocol-driven initiation within the ED, careful patient selection, and continuous monitoring for physiological response. Predictors of NIV failure include severe acidosis (pH < 7.25), impaired consciousness, and high illness severity scores, necessitating timely escalation to invasive ventilation. While generally safe, managing patient tolerance and interface-related complications is crucial. Despite robust evidence, variations in clinical practice highlight the need for standardized ED protocols, staff education, and dedicated equipment. NIV remains an indispensable, life-saving therapy in emergency respiratory care, fundamentally improving outcomes for patients with severe AECOPD when implemented effectively as part of an integrated clinical pathway