Clinical Stabilization of Hypercapnia: NIPPV v HVNI

Inclusion Criteria: * Adults, 18 years or older with a known or suspected diagnosis of COPD * Presentation with acute hypercapnic respiratory failure * Moderate to Severe patient baseline hypercarbia/hypercapnia, defined as a baseline PCO2 of 60 mmHg or higher * Venous pH of 7.0 - 7.35 Exclusion Criteria: * Severe metabolic derangements (e.g. suspected drug overdose, mixed acid/base disorder) * Need for airway protection * Primary condition of Congestive Heart Failure * Need for emergent intubation * Pneumonia diagnosis with significant infiltrate on chest x-ray that is clinically correlated with pneumonia * Inability to provide informed consent * Pregnancy * Known contraindication to perform procedures listed, or therapies described in the protocol * Respiratory arrest or significant respiratory depression on presentation * Significant nasal occlusion either unilateral or bilateral * Absence of spontaneous respiration or known contraindication to HVNI * Extreme agitation or uncooperativeness that would hinder either arm of randomized therapy * Determined by the clinician to be sufficiently unstable or unsuitable for this study