Sharma Sunil, Stansbury Robert, Mudgal Mayuri, Srinivasan Priyanka, Rojas Edward, Olgers Kassandra K, Knollinger Scott, Selim Bernardo J, Wen Sijin
Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
PLoS One. 2025 Apr 16;20(4):e0321420. doi: 10.1371/journal.pone.0321420. eCollection 2025.
Patients with acute-on-chronic hypercapnic respiratory failure suffer from recurrent readmissions due to acute exacerbations. These patients carry higher readmission and mortality rates compared to the general population.
We aimed to delineate the outcomes of patients discharged on non-invasive ventilation.
A cross-sectional study was conducted. One hundred nine patients with acute-on-chronic hypercapnic respiratory failure were evaluated and qualified for non-invasive ventilation at discharge. Adherence data was collected post-discharge and the following outcomes were evaluated: 12-month mortality, 6-month hospital readmission, and emergency department visits in patients who were adherent with non-invasive ventilation therapy versus non-adherent and controls.
Of the 95 patients discharged on non-invasive ventilation, 25 patients (26%) were found to be adherent to post-discharge home non-invasive ventilation. The adherent group had significantly lower 12-month mortality (p=0.022). Survival benefit persisted on multivariate analysis with the Cox regression model adjusting for comorbidities and demographics (HR = 0.05, p=0.04). The study also observed reduced emergency department visits in the non-invasive ventilation-adherent group compared to the non-adherent (3% vs 17%) [p=0.049] and controls (3% vs 25%) [p=0.024].
Hypercapnic respiratory failure patients discharged home with non-invasive ventilation in the adherent group had significantly lower mortality and emergency department visits. Apart from mask intolerance, low health literacy and transfer to skilled nursing facilities were identified as major reasons for non-adherence.
患有急性慢性高碳酸血症呼吸衰竭的患者因急性加重而反复入院。与普通人群相比，这些患者的再入院率和死亡率更高。
我们旨在描述无创通气出院患者的结局。
进行了一项横断面研究。对109例急性慢性高碳酸血症呼吸衰竭患者进行了评估，这些患者在出院时符合无创通气条件。出院后收集依从性数据，并评估以下结局：12个月死亡率、6个月再入院率，以及依从无创通气治疗的患者与不依从患者及对照组患者的急诊科就诊情况。
在95例接受无创通气出院的患者中，发现25例（26%）患者出院后在家坚持无创通气。依从组的12个月死亡率显著较低（p = 0.022）。在对合并症和人口统计学因素进行调整的Cox回归模型多变量分析中，生存获益持续存在（HR = 0.05，p = 0.04）。该研究还观察到，与不依从组（3%对17%）[p = 0.049]和对照组（3%对25%）[p = 0.024]相比，无创通气依从组的急诊科就诊次数减少。
依从组中接受无创通气出院回家的高碳酸血症呼吸衰竭患者的死亡率和急诊科就诊次数显著较低。除了面罩不耐受外，健康素养低和转至专业护理机构被确定为不依从的主要原因。
