<title>Abstract</title> <bold>Background</bold> The trend overtime and across different geographical areas of outcomes and management with noninvasive ventilation or invasive mechanical ventilation in patients admitted for acute exacerbations of chronic obstructive pulmonary disease and treated with ventilatory support is unknown. The purpose of this study was to<bold> </bold>describe outcomes and identify variables associated with survival for patients admitted to an intensive care unit (ICU) with acute exacerbation of chronic obstructive pulmonary disease [aeCOPD] that received noninvasive or invasive mechanical ventilation worldwide. <bold>Methods: </bold>Retrospective, multi-national and multicenter study, including four observational cohort studies carried out in 1998, 2004, 2010, 2016 for the VENTILAGROUP following the same methodology. <bold>Reesults:</bold> A total of 1,848 patients from 1,253 ICU in 38 countries admitted for aeCOPD and need of ventilatory support were identified in the four study cohorts and included in the study. The overall incidence of aeCOPD as cause for ventiltory support at ICU admission significantly decreased over time and varied widely according to the gross national income. The mortality of patients admitted to ICU for aeCOPD and ventilatory support significantly decreased over time regardless of the geographical area and gross national income; however, there is a remarkable variability in ICU mortality according to geographical area and gross national income. The use of NPPV as first attempt of ventilatory support has significantly increased over time, with a parallel reduction of invasive mechanical ventilation regardless of gross national income. <bold>Conclusions:</bold> in this worldwide observational study including four different sequential cohorts of patients over a time span of 18 years from 1998 to 2016, the mortality of patients admitted to ICU for aeCOPD and ventilatory support significantly decreased regardless of the geographical area and gross national income. Future research will need to investigate reason for the remarkable variability in ICU mortality according to geographical area, gross national income and methods to select patients for the appropriate ventilatory support.