Effectiveness of Non-Invasive Ventilation vs. Invasive Ventilation in Acute COPD Exacerbation: A Meta-Analysis of Randomized and Observational Studies

Safwat Mohamed Mohamed Elshewy; Rawal Hussain; Yasser Hijazi Abdoon Osman; Ayesha Imran Ch; Haseeb Wajid; Muzammil Ahmed; Anusha Javed Khan; Aqsa Akram

doi:10.70749/ijbr.v3i3.959

Authors

Safwat Mohamed Mohamed Elshewy Dubai Health, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai.
Rawal Hussain Muhammad Medical College Mirpur Khas Affiliated with Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan.
Yasser Hijazi Abdoon Osman Najran Armed Forces Hospital, Najran, KSA.
Ayesha Imran Ch Foundation University School of Health Sciences (FUSH), Islamabad, Pakistan.
Haseeb Wajid Faisalabad Medical University, Faisalabad, Pakistan.
Muzammil Ahmed Faisalabad Medical University, Faisalabad, Pakistan.
Anusha Javed Khan Faisalabad Medical University, Faisalabad, Pakistan.
Aqsa Akram People’s University of Medical and Health Sciences PUMHS.

DOI:

https://doi.org/10.70749/ijbr.v3i3.959

Keywords:

COPD, Non-invasive Ventilation, Invasive Mechanical Ventilation, Meta-analysis, Acute Exacerbation, Mortality, Intubation

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often lead to acute respiratory failure, requiring ventilatory support. While invasive mechanical ventilation (IMV) is traditionally used, non-invasive ventilation (NIV) has emerged as a promising alternative with potentially fewer complications. This meta-analysis aimed to compare the effectiveness of NIV versus IMV or standard care in managing AECOPD. Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science for studies published up to March 2024. Randomized controlled trials and observational studies comparing NIV with IMV or standard therapy in adult AECOPD patients were included. The primary outcomes were intubation rate, in-hospital mortality, and hospital length of stay. Statistical analyses were performed using Review Manager (RevMan) version 5.4, applying a random-effects model. Risk of bias was assessed using the Cochrane RoB 2.0 and Newcastle-Ottawa Scale. Results: Three studies were included, comprising 70,141 patients. NIV significantly reduced the risk of intubation (RR: 0.34; 95% CI: 0.33–0.35; I² = 0%) and in-hospital mortality (RR: 0.43; 95% CI: 0.30–0.64; I² = 3%) compared to IMV or standard care. However, no statistically significant difference was observed in hospital length of stay (MD: 0.81 days; 95% CI: –5.79 to 7.42; I² = 79%). Funnel plots suggested minimal publication bias. Conclusion: NIV is significantly more effective than IMV or standard care in reducing both intubation rates and in-hospital mortality in AECOPD patients. While its impact on hospital stay remains inconclusive, these findings support NIV as a frontline strategy in acute COPD management. Further high-quality research is needed to assess long-term outcomes and optimize patient selection.

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