Pragmatic Pathways for Noninvasive Ventilation in Type 2 Respiratory Failure: From Global Evidence to Nepalese Experience

Abstract

Noninvasive ventilation (NIV) is an established first-line intervention for Type 2 (hypercapnic) respiratory failure, offering a highly effective and less invasive alternative to endotracheal intubation. Its efficacy is rooted in core mechanisms, such as pressure support-driven improvements in gas exchange, which address principal causes like COPD and neuromuscular disorders. Several evidence confirms that this approach significantly reduces mortality, morbidity, and hospital length of stay, while preserving natural airway function and patient comfort. While arterial blood gas (ABG) analysis remains the gold standard for initiating therapy, pragmatic clinical indicators—such as tachypnea and accessory muscle use—are vital in resource-constrained settings like Nepal. Building on this foundation, recent advances in pulmonology, including portable ventilators, telemonitoring, and AI-powered analytics, are further elevating patient outcomes. To realize the full potential of these tools, their integration within multidisciplinary teams and expanded access through robust critical care infrastructure are essential for improving survival and quality of life. Therefore, this paper aims to outline a modern, integrated strategy for managing hypercapnic failure that combines advanced technology with equitable, accessible noninvasive ventilation.