Outcome of Early Bi-Level Positive Airway Pressure (BiPAP) Use in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a major global health problem and a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD frequently result in acute hypercapnic respiratory failure, necessitating ventilatory support. Noninvasive ventilation (NIV), particularly bi-level positive airway pressure (BiPAP), has emerged as a preferred modality during acute exacerbations due to its ability to improve gas exchange, reduce the work of breathing, and decrease the need for invasive mechanical ventilation. Objective: To determine the outcome of early Bi-level positive airway pressure (BiPAP) use in patients presenting with acute exacerbation of COPD at a tertiary care hospital in Karachi. Methodology: This prospective observational cohort study was conducted in the Department of Medicine, Abbasi Shaheed Hospital, Karachi, from January 7, 2021, to June 7, 2021. A total of 118 patients aged 30–70 years with a diagnosis of COPD for more than one year, presenting with acute exacerbation and hypercapnic respiratory failure, were enrolled using non-probability consecutive sampling. Early BiPAP therapy was initiated alongside standard medical treatment. Clinical parameters and arterial blood gas values were monitored. Outcomes were categorized as successful or failed based on the need for invasive mechanical ventilation. Data were analyzed using SPSS version 16. Results: Out of 118 patients, 96 (81.4%) achieved a successful outcome following early BiPAP therapy, while 22 (18.6%) experienced treatment failure. The mean age was 57.87 ± 15.64 years. Significant improvement was observed in post-NIV arterial pH, PaO₂, and PaCO₂ levels. Multivariate analysis demonstrated that post-NIV pH and PaCO₂ were independent predictors of BiPAP success (p < 0.05). Conclusion: Early initiation of BiPAP in patients with acute exacerbation of COPD was generally well tolerated and associated with a high success rate. This noninvasive strategy has the potential to reduce the need for invasive mechanical ventilation, hospital morbidity, and healthcare costs. Keywords: Acute COPD Exacerbation, Bi-Level Positive Airway Pressure, Noninvasive Ventilation.