Outcome of different modes of non-invasive ventilation in chronic obstructive pulmonary disease patients with type II respiratory failure

Background: Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory airway disorder often leading to type II respiratory failure (RF). Non-invasive ventilation (NIV) is crucial in COPD management. This study compares T (Timed), ST (Spontaneous-Timed), and iVAPS (Intelligent volume assured pressure support) modes. Method: A prospective, experimental, comparative study spanned two years. One hundred COPD patients with Type 2 RF were randomized into three groups: T mode (n=33), ST mode (n=33), and iVAPS mode (n=34). Outcome assessment included clinical, hematological parameters, and intubation rate. Result: The study revealed varying degrees of success among the three modes of NIV. iVAPS mode demonstrated the highest success rate, with 79.4% of cases achieving positive outcomes. Noteworthy improvements were observed in respiratory rate (RR) and oxygen saturation (SpO2) in the iVAPS group after 12 hours of NIV. Both the ST mode and iVAPS mode showed significant increases in pH levels, with a more pronounced improvement seen in the iVAPS group. Additionally, a substantial reduction in pCO2 levels after BiPAP was noted in the iVAPS group. The intubation rate was lowest in the iVAPS group, though the difference did not reach statistical significance. Conclusions: iVAPS mode demonstrated superior outcomes, including significant improvements in RR, SpO2, pH, and pCO2. While the intubation rate was lowest in the iVAPS group, statistical significance was not achieved. iVAPS emerges as a promising alternative, potentially averting the need for invasive ventilation. Larger, diverse studies are needed to validate these findings.