This study investigates the reliability and clinical usefulness of non-invasive electrical cardiometry (ICON® device) in monitoring hemodynamic changes in COPD patients admitted to the respiratory intensive care unit (RICU).

hemodynamic monitoring is critical in critically ill patients, especially those with COPD experiencing acute respiratory failure. Traditional invasive methods such as pulmonary artery catheterization are accurate but carry procedural risks. The ICON® device enables real-time, continuous, non-invasive assessment of parameters like cardiac output, stroke volume, systemic vascular resistance, and thoracic fluid content using thoracic bioimpedance. This prospective observational study will assess its reliability against clinical outcomes and evaluate the influence of different ventilation strategies (invasive, non-invasive, no ventilation) on hemodynamic changes. Data will be collected serially throughout ICU stay to determine ICON's contribution to optimizing patient management and risk stratification.

Inclusion Criteria:

• Age ≥ 18 years

Admission to RICU with COPD or COPD-related acute respiratory failure

Informed consent provided by patient or legal representative

Exclusion Criteria:

• patients <18 years

Pregnant women

Injuries, burns, or skin conditions preventing electrode placement

Patients with uncontrolled seizures

Patients needing electrical DC shock

Refusal or withdrawal of informed consent

The study population includes adult patients (≥18 years) admitted with a confirmed diagnosis of COPD or COPD-related acute respiratory failure requiring ICU admission. Patients may present with hypoxemia, hypercapnia, or both. Participants will include both male and female patients admitted for exacerbations or decompensation, receiving either invasive mechanical ventilation, non-invasive mechanical ventilation, or supplemental oxygen. Exclusions include patients with electrode placement limitations (e.g., skin injuries), seizure disorders, pregnancy, or those refusing consent.