The following is the summary of “Timing of Treatment Outcomes and Risk Factors for Failure of BPAP in Patients Hospitalized for COPD Exacerbation” published in December 2022 issue of Respiratory Care by Mosher, et al.

Hospitalized patients with COPD exacerbation are at a higher risk of mortality, and those who fail bi-level positive airway pressure (BPAP) for hypercapnic respiratory failure and require invasive mechanical ventilation are at especially high risk. As a result, researchers set out to learn more about the BPAP treatment timeline and what factors contribute to BPAP treatment failure. Patients hospitalized for an exacerbation of their COPD were studied in a retrospective cohort study that made use of real-world evidence. Within 7 days of starting BPAP, patients were classified as either failing, persisting, or succeeding. For this study, failure was considered to be either death or the need for invasive ventilation. The use of BPAP after 7 days in the hospital was considered persistent. 

Release from BPAP before hospital day 7 and failure to meet requirements was considered a success. Investigators utilized multinomial logistic regression models without adjustment to look at how 17 different recipient characteristics were linked to BPAP treatment outcomes. The outcomes of the 427 clinical interactions were as follows: 78% success, 10% persistence, and 12% failure. They found that the average time to either succeed or fail was 8 hours and 16 hours, respectively. 

Both treatment failure and persistence with BPAP were substantially correlated with age, body mass index (BMI), bicarbonate, and creatinine levels.  Patients are at significant risk for life-threatening decompensation in the first 8 hours after starting BPAP. Factors linked with BPAP treatment failure or persistence include advancing age, BMI, bicarbonate level, and creatinine level.


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