While non-invasive ventilation (NIV) is recommended for managing acute exacerbations of chronic obstructive pulmonary disease (AECOPD), it has a 30–40% failure rate when delivered using pressure support ventilation (PSV). Adaptive support ventilation with IntelliSync (ASVi) synchronizes breath initiation and cycling to match patient's requirements. We conducted a feasibility study to inform design of a larger trial and compared NIV failure rates using PSV or ASVi in patients with AECOPD.

We conducted a single-center, randomized controlled trial from December 2023 to April 2025 in subjects with AECOPD. Subjects were randomized (1:1) to receive NIV using PSV or ASVi. The primary outcome was NIV failure, defined as the need for airway intubation. Key secondary outcomes included the asynchrony index and 28-day all-cause mortality.

We included 55 consecutive subjects with AECOPD (ASVi, n = 26; PSV, n = 29), with a mean age of 63 years. NIV failure occurred in15.4% (4/26) with ASVi versus 31% (9/29) with PSV, representing a 50% relative risk reduction (absolute difference 15.6%, 95% CI: −6.2%–37.5%, P = 0.17). Asynchrony index was similar between groups (22.6 ± 17.8 ASVi vs. 21.5 ± 16.7 PSV, P = 0.83). ASVi was associated with significantly greater patient comfort (P = 0.048) and shorter hospital stay (3.9 ± 2.9 vs 5.8 ± 4.0 days, P = 0.021).

This study demonstrates that ASVi is safe, feasible to implement, and associated with improved patient comfort and significantly reduced hospital stay in AECOPD. The observed 50% relative reduction in NIV failure rates, although not statistically significant, represents a clinically meaningful effect that warrants evaluation in a larger trial.