{"doi":"10.4187/respcare.10813","title":"Lowering P <sub> CO <sub>2</sub> </sub> With Noninvasive Ventilation Is Associated With Improved Survival in Chronic Hypercapnic Respiratory Failure","abstract":"BACKGROUND: 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 P CO 2 reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia. METHODS: The objective of this study was to investigate the association between P CO 2 reduction (by using transcutaneous P CO 2 as an estimate for P aCO 2 and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia. We hypothesized that reductions in P CO 2 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 P CO 2 as a time-varying covariate to test the association between P CO 2 and all-cause mortality and when adjusting for known cofounders. RESULTS: The 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 P CO 2 to &lt; 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 P CO 2 . In the multivariable analysis, the subjects who had a P aCO 2 &lt; 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). CONCLUSIONS: Reduction in P CO 2 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 P CO 2 .","journal":"Respiratory Care","year":2023,"id":338343,"datarank":0.44166584687496613,"base_score":2.9444389791664403,"endowment":2.9444389791664403,"self_citation_contribution":0.44166584687496613,"citation_network_contribution":0.0,"self_endowment_contribution":0.44166584687496613,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9629,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1061384,"name":"Jason Ackrivo","orcid":"0000-0003-4379-1255","position":1,"is_corresponding":false},{"id":337715,"name":"Jesse Y. Hsu","orcid":"0000-0002-1522-6534","position":2,"is_corresponding":false},{"id":1071233,"name":"Mathew W. Wilson","orcid":null,"position":3,"is_corresponding":false},{"id":309293,"name":"Wassim W. Labaki","orcid":"0000-0002-3203-5537","position":4,"is_corresponding":false},{"id":1070757,"name":"John Hansen‐Flaschen","orcid":"0000-0003-1989-7244","position":5,"is_corresponding":false},{"id":1070758,"name":"Robert C. Hyzy","orcid":"0000-0003-1890-4932","position":6,"is_corresponding":false},{"id":1070759,"name":"Philip J. Choi","orcid":"0000-0003-3609-5999","position":7,"is_corresponding":false},{"id":1070756,"name":"José Víctor Jiménez","orcid":"0000-0002-9209-0327","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:10:35.973121Z","pmid":"37137711","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}