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Abstract
BACKGROUND: Patients hospitalized for COPD exacerbation have an increased risk of mortality, particularly among those who fail bi-level positive airway pressure (BPAP) for hypercapnic respiratory failure subsequently requiring invasive mechanical ventilation. Therefore, we sought to investigate the treatment course of BPAP and factors associated with BPAP treatment failure.
METHODS: We performed a retrospective cohort study using real-world evidence to investigate subjects with COPD who were treated with BPAP during a hospitalization for COPD exacerbation. Treatment outcomes were defined within 7 d from BPAP initiation as either failure, persistent, or success. Failure was defined as death or progression to invasive ventilation. Persistent was defined as receiving BPAP during hospital day 7. Success was defined as liberation from BPAP prior to hospital day 7 and not meeting criteria for failure. Unadjusted multinomial logistic regression models were used to examine the association between BPAP treatment outcomes and 17 recipient characteristics.
RESULTS: Among the 427 clinical encounters, 78% were successful, 10% were persistent, and 12% experienced failure. The median time to failure and success was 8 h and 16 h, respectively. Increasing age, body mass index (BMI), bicarbonate level, and creatinine level were significantly associated with either BPAP treatment failure, persistent treatment, or both.
CONCLUSIONS: The first 8 h following initiation of BPAP is a critical time period where patients are at high risk for life-threatening decompensation. Careful consideration should be given to increasing age, BMI, bicarbonate level, and creatinine level as these factors were associated with BPAP treatment failure or persistent treatment.
- COPD
- exacerbation
- bi-level positive airway pressure (BPAP)
- risk factors
- noninvasive ventilation
- hypercapnic respiratory failure
- electronic health record
Footnotes
- Correspondence: Christopher L Mosher MD MHS, Duke Clinical Research Institute, 300 W. Morgan Street, Office 521, Durham, NC, 27701. E-mail: christopher.mosher{at}duke.edu
See the Related Editorial on Page 1642
Dr MacIntyre discloses relationships with InspiRx, Phillips, Hillrom, and Inogen. The remaining authors have disclosed no conflicts of interest.
Dr Mosher received research support from the National Institutes of Health (NIH) (5T32HL007538-35) and support through the CHEST Foundation to complete this project. The NIH and CHEST Foundation were not involved in the research study or in the presentation of our findings.
Supplementary material related to this paper is available at http://www.rcjournal.com.
- Copyright © 2022 by Daedalus Enterprises
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