Comparison of High-Intensity and Low-Intensity Non-Invasive Ventilation in Acute COPD Exacerbations

INTERVENTION: Intervention1: High Intensity NIV: High‐intensity NIV using oronasal mask: Mode Pressure assist control. The inspiratory pressure will be started at 12 cm of H2O EPAP at 6 cm of H2O and gradually increased to obtain a tidal volume of 10‐15 mLper kg typically in the range of 18‐20 cm H2O. Control Intervention1: Low Intensity NIV: The IPAP will be set to obtain a tidal volume of 6‐8 mL per kg EPAP set at 6 cm of H2O. CONDITION: Health Condition 1: J441‐ Chronic obstructive pulmonary disease with (acute) exacerbation PRIMARY OUTCOME: Need for Endo‐tracheal intubationTimepoint: During hospital stay SECONDARY OUTCOME: Adverse effectsTimepoint: During Hospital stay All cause in hospital mortalityTimepoint: During hospital stay Change in arterial PaCO2, PaO2 & pHTimepoint: 1,12, 24 & 48 hours Days of NIV useTimepoint: During hospital stay Length of hospital stayTimepoint: During hospital stay INCLUSION CRITERIA: Consecutive COPD patients admitted to ICU with AECOPD confirmed by the 2025 criteria of the Global Initiative for Chronic Obstructive Lung Disease Arterial pH less than 7.35 PaCO2 more than 45 mmHg even after one hour of optimal bronchodilator therapy