Head-To-Head Comparison of Treatment Failure and Costs among COPD Patients Who Used Noninvasive Ventilation in the Ward versus in the ICU: A Propensity-Matched Cohort Study

Abstract

Background. Head-to-head comparison of treatment failure and costs among chronic obstruct pulmonary disease (COPD) patients who used noninvasive ventilation (NIV) in the ward versus in the ICU is lacking. Methods. This retrospective study was performed in a department of respiratory and critical care medicine in a teaching hospital. COPD patients who used NIV in the respiratory ward or respiratory ICU were screened. We enrolled patients with PaCO2 more than 45 mmHg and pH less than 7.35 before the use of NIV. Results. We enrolled 83 patients who initiated NIV in the ward and 319 patients in the ICU. Only 5 (6%) patients in the ward were required to transfer to ICU for intensive care. The vital signs were worse but improved faster within 24 h of NIV among patients in the ICU than those in the ward. The NIV failure, hospital mortality, and the length of stay in hospital did not differ between the two groups. However, the duration of NIV was shorter (median 4.0 vs. 6.1 days, $p<0.01$ ) and hospital costs were higher (median 4638 vs. 3093 $USD, $p<0.01$ ) among patients in the ICU than those in the ward. After propensity matching, 42 patients were left in each group, and the baseline data were comparable between the two groups. The findings in the overall cohort were confirmed again in the propensity-matched cohort. Conclusions. Among COPD patients, the use of NIV in the ward leads to longer duration of NIV, but lower hospital costs, and similar NIV failure and mortality compared with those in the ICU.