Related Experiment Video
Updated: May 14, 2026

3D Cine Magnetic Resonance Imaging of Respiratory Motion in Mechanically Ventilated Mice and Rats
Published on: September 19, 2025
Comparative effectiveness of noninvasive ventilation vs invasive mechanical ventilation in chronic obstructive
Chu-Lin Tsai1, Wen-Ya Lee, George L Delclos
1Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030, USA. cltsai@post.harvard.edu
Background:
Limited evidence exists on the comparative effectiveness of noninvasive ventilation (NIV) vs invasive mechanical ventilation (IMV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with respiratory failure.
Objectives:
To characterize the use of NIV and IMV, and to compare the effectiveness of NIV vs IMV in AECOPD.
Design And Patients:
Retrospective cohort study using data from the 2006-2008 Nationwide Emergency Department Sample. Emergency department visits for AECOPD with acute respiratory failure were identified with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.
Measures:
The outcome measures were inpatient mortality, hospital length of stay, hospital charges, and complications.
Results:
There were an estimated 101,000 visits annually for AECOPD with acute respiratory failure; 96% were admitted to the hospital. Of these, NIV use increased from 14% in 2006 to 16% in 2008 (P=0.049). Use of NIV, however, varied widely between hospitals, ranging from 0% to 100% with a median of 11%. Noninvasive ventilation was more often used in higher-case volume, Northeastern hospitals. In a propensity score analysis, NIV use, compared with IMV, was associated with lower inpatient mortality (risk ratio: 0.54, 95% confidence interval [CI]: 0.50-0.59), shortened hospital length of stay (-3.2 days; 95% CI: -3.4 to -2.9 days), lower hospital charges (-$35,012; 95% CI: -$36,848 to -$33,176), and lower risk of iatrogenic pneumothorax (0.05% vs 0.5%, P<0.001).
Conclusions:
Although NIV use is increasing in US hospitals, its adoption remains low and varies widely between hospitals. Our observational study suggests NIV appears to be more effective and safer than IMV for AECOPD in the real-world setting.
Related Concept Videos
Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Mechanical Ventilation I: Indication and Settings
Acute Respiratory Failure-III
Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...