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, ) and hospital costs were higher (median 4638 vs. 3093 $USD, ) 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.

中文翻译：

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在病房和 ICU 中使用无创通气的 COPD 患者治疗失败和成本的头对头比较：倾向匹配队列研究

背景。缺乏在病房和 ICU 中使用无创通气 (NIV) 的慢性阻塞性肺病 (COPD) 患者的治疗失败和成本的头对头比较。方法。这项回顾性研究是在教学医院的呼吸和重症监护医学科进行的。对在呼吸病房或呼吸病房使用 NIV 的 COPD 患者进行筛查。我们纳入了使用 NIV 前PaCO ₂超过 45 mmHg 且 pH 值低于 7.35 的患者。结果. 我们招募了 83 名在病房开始 NIV 的患者和 319 名在 ICU 开始的患者。病房中只有 5 名（6%）患者需要转入 ICU 进行重症监护。与病房患者相比，ICU 患者在 NIV 后 24 小时内生命体征更差但改善更快。两组的 NIV 失败、住院死亡率和住院时间没有差异。然而，NIV 的持续时间较短（中位数 4.0 天对 6.1 天，)和住院费用更高（中位数 4638 美元对 3093 美元，) ICU 中的患者多于病房中的患者。倾向匹配后每组剩余42例患者，两组基线资料具有可比性。在倾向匹配的队列中再次证实了整个队列的发现。结论。在 COPD 患者中，与 ICU 相比，在病房使用 NIV 导致 NIV 持续时间更长，但住院费用更低，并且 NIV 失败和死亡率相似。