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Lowering P<sub>CO<sub>2</sub></sub>with Non-Invasive Ventilation is Associated with Improved Survival in Chronic Hypercapnic Respiratory Failure release_zcbto76ltjh4zintv6iguog7fa

by Jose Victor Jimenez, Jason Ackrivo, Jesse Y Hsu, Mathew W Wilson, Wassim W Labaki, John Hansen-Flaschen, Robert C Hyzy, Philip J Choi

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abstracts[] {'sha1': 'c138ad90f2363b4d31d969c0253582d1a4b53de1', 'content': 'Chronic hypercapnic respiratory failure is associated with high mortality. Although previous work has demonstrated a mortality improvement with high-intensity noninvasive ventilation in COPD, it is unclear whether a PCO2 reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia.\nThe objective of this study was to investigate the association between PCO2 reduction (by using transcutaneous PaO2 as an estimate for PaCO2 and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia. We hypothesized that reductions in PCO2 would be associated with improved survival. Therefore, we performed a cohort study of all the subjects evaluated from February 2012 to January 2021 for noninvasive ventilation initiation and/or optimization due to chronic hypercapnia at a home ventilation clinic in an academic center. We used multivariable Cox proportional hazard models with time-varying coefficients and PCO2 as a time-varying covariate to test the association between PCO2 and all-cause mortality and when adjusting for known cofounders.\nThe mean ± SD age of 337 subjects was 57 ± 16 years, 37% women, and 85% white. In a univariate analysis, survival probability increased with reductions in PCO2 to < 50 mm Hg after 90 d, and these remained significant after adjusting for age, sex, race, body mass index, diagnosis, Charlson comorbidity index, and baseline PCO2 . In the multivariable analysis, the subjects who had a PaCO2 < 50 mm Hg had a reduced mortality risk of 94% between 90 and 179 d (hazard ratio [HR] 0.06, 95% CI 0.01-0.50), 69% between 180 and 364 d (HR 0.31, 95% CI 0.12 - 0.79), and 73% for 365-730 d (HR 0.27, 95% CI 0.13-0.56).\nReduction in PCO2 from baseline for subjects with chronic hypercapnia treated with noninvasive ventilation was associated with improved survival. Management strategies should target the greatest attainable reductions in PCO2 .', 'mimetype': 'text/plain', 'lang': 'en'}
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issue 12
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release_date 2023-05-03
release_stage published
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subtitle
title Lowering P<sub>CO<sub>2</sub></sub>with Non-Invasive Ventilation is Associated with Improved Survival in Chronic Hypercapnic Respiratory Failure
version
volume 68
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crossref.alternative-id ['10.4187/respcare.10813']
crossref.subject ['Critical Care and Intensive Care Medicine', 'Pulmonary and Respiratory Medicine', 'General Medicine']
crossref.type journal-article
pubmed.pub_types ['Journal Article']