{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:47:09Z","timestamp":1791830829372,"version":"4.3.4"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec>\n<jats:title>Rationale<\/jats:title>\n<jats:p>Patients with acute-on-chronic hypercapnic respiratory failure suffer from recurrent readmissions due to acute exacerbations. These patients carry higher readmission and mortality rates compared to the general population.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>We aimed to delineate the outcomes of patients discharged on non-invasive ventilation.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional study was conducted. One hundred nine patients with acute-on-chronic hypercapnic respiratory failure were evaluated and qualified for non-invasive ventilation at discharge. Adherence data was collected post-discharge and the following outcomes were evaluated: 12-month mortality, 6-month hospital readmission, and emergency department visits in patients who were adherent with non-invasive ventilation therapy versus non-adherent and controls.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Measurements and main results<\/jats:title>\n<jats:p>Of the 95 patients discharged on non-invasive ventilation, 25 patients (26%) were found to be adherent to post-discharge home non-invasive ventilation. The adherent group had significantly lower 12-month mortality (p=0.022). Survival benefit persisted on multivariate analysis with the Cox regression model adjusting for comorbidities and demographics (HR = 0.05, p=0.04). The study also observed reduced emergency department visits in the non-invasive ventilation-adherent group compared to the non-adherent (3% vs 17%) [p=0.049] and controls (3% vs 25%) [p=0.024].<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Hypercapnic respiratory failure patients discharged home with non-invasive ventilation in the adherent group had significantly lower mortality and emergency department visits. Apart from mask intolerance, low health literacy and transfer to skilled nursing facilities were identified as major reasons for non-adherence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0321420","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T17:30:33Z","timestamp":1744824633000},"page":"e0321420","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Post-Discharge non-invasive ventilation for hypercapnic respiratory failure: Outcomes in a Rural Cohort"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6006-8240","authenticated-orcid":true,"given":"Sunil","family":"Sharma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stansbury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuri","family":"Mudgal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6086-0895","authenticated-orcid":true,"given":"Priyanka","family":"Srinivasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Rojas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8599-9560","authenticated-orcid":true,"given":"Kassandra K.","family":"Olgers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Knollinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo J.","family":"Selim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijin","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"issue":"12","key":"pone.0321420.ref001","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1136\/thx.2004.024307","article-title":"Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure","volume":"59","author":"CM Chu","year":"2004","journal-title":"Thorax"},{"issue":"1","key":"pone.0321420.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.amjmed.2003.08.022","article-title":"Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome","volume":"116","author":"S Nowbar","year":"2004","journal-title":"Am J Med"},{"issue":"2","key":"pone.0321420.ref003","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/resp.14388","article-title":"Causes of hypercapnic respiratory failure and associated in-hospital mortality","volume":"28","author":"Y Chung","year":"2023","journal-title":"Respirology"},{"key":"pone.0321420.ref004","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2147\/OAEM.S242075","article-title":"Hypercapnia at Hospital Admission as a Predictor of Mortality","volume":"12","author":"S Vonderbank","year":"2020","journal-title":"Open Access Emerg Med"},{"issue":"1","key":"pone.0321420.ref005","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00408-019-00300-w","article-title":"Risk of Readmission and Mortality Following Hospitalization with Hypercapnic Respiratory Failure","volume":"198","author":"AJ Meservey","year":"2020","journal-title":"Lung"},{"issue":"1","key":"pone.0321420.ref006","first-page":"CD004104","article-title":"Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease","author":"FSF Ram","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"pone.0321420.ref007","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1136\/thorax.57.3.192","article-title":"Non-invasive ventilation in acute respiratory failure","volume":"57","author":"British Thoracic Society Standards of Care Committee","year":"2002","journal-title":"Thorax"},{"issue":"3","key":"pone.0321420.ref008","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0272-5231(05)70330-0","article-title":"Noninvasive positive-pressure ventilation in patients with acute respiratory failure","volume":"17","author":"GU Meduri","year":"1996","journal-title":"Clin Chest Med"},{"issue":"7","key":"pone.0321420.ref009","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1136\/thx.2008.108274","article-title":"Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial","volume":"64","author":"RD McEvoy","year":"2009","journal-title":"Thorax"},{"issue":"6","key":"pone.0321420.ref010","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1136\/thx.53.6.495","article-title":"Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long-term follow up and effect on survival","volume":"53","author":"SE Jones","year":"1998","journal-title":"Thorax"},{"issue":"1","key":"pone.0321420.ref011","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/1465-9921-12-112","article-title":"Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: a randomized controlled trial","volume":"12","author":"ML Duiverman","year":"2011","journal-title":"Respir Res"},{"key":"pone.0321420.ref012","author":"West Virginia Department of Health and Human Resources","year":"2011"},{"key":"pone.0321420.ref013","author":"Centers for Disease Control and Prevention"},{"issue":"7","key":"pone.0321420.ref014","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1111\/crj.13354","article-title":"The impact of a telemedicine intervention on home non-invasive ventilation in a rural population with advanced COPD","volume":"15","author":"R Leonard","year":"2021","journal-title":"Clin Respir J"},{"issue":"1","key":"pone.0321420.ref015","doi-asserted-by":"crossref","first-page":"e001267","DOI":"10.1136\/bmjresp-2022-001267","article-title":"Transitioning from hospital to home with non-invasive ventilation: who benefits? Results of a cohort study","volume":"9","author":"BD Fox","year":"2022","journal-title":"BMJ Open Respir Res"},{"issue":"4","key":"pone.0321420.ref016","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.chest.2021.10.016","article-title":"Sleep-Disordered Breathing in Hospitalized Patients: A Game Changer?","volume":"161","author":"S Sharma","year":"2022","journal-title":"Chest"},{"key":"pone.0321420.ref017"},{"issue":"4","key":"pone.0321420.ref018","doi-asserted-by":"crossref","first-page":"e191919","DOI":"10.1001\/jamanetworkopen.2019.1919","article-title":"Trends in Emergency Department Use by Rural and Urban Populations in the United States","volume":"2","author":"MB Greenwood-Ericksen","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"5","key":"pone.0321420.ref019","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1513\/AnnalsATS.201912-887OC","article-title":"The Effect of Hospital Discharge with Empiric Noninvasive Ventilation on Mortality in Hospitalized Patients with Obesity Hypoventilation Syndrome. An Individual Patient Data Meta-Analysis","volume":"17","author":"B Mokhlesi","year":"2020","journal-title":"Ann Am Thorac Soc"},{"issue":"4","key":"pone.0321420.ref020","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/j.1365-2796.2007.01765.x","article-title":"Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation","volume":"261","author":"S Budweiser","year":"2007","journal-title":"J Intern Med"},{"issue":"5","key":"pone.0321420.ref021","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.rmed.2014.03.006","article-title":"Home non-invasive ventilation use following acute hypercapnic respiratory failure in COPD","volume":"108","author":"JA Galli","year":"2014","journal-title":"Respir Med"},{"issue":"6","key":"pone.0321420.ref022","first-page":"e15770","article-title":"The Burden of Obesity in the Rural Adult Population of America","volume":"13","author":"OE Okobi","year":"2021","journal-title":"Cureus"},{"issue":"21","key":"pone.0321420.ref023","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1001\/jama.2017.4451","article-title":"Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial","volume":"317","author":"PB Murphy","year":"2017","journal-title":"JAMA"},{"issue":"2","key":"pone.0321420.ref024","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.mayocpiqo.2022.01.002","article-title":"Continuous Positive Airway Pressure Adherence and Treatment Cost in Patients With Obstructive Sleep Apnea and Cardiovascular Disease","volume":"6","author":"JM Bock","year":"2022","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"issue":"8","key":"pone.0321420.ref025","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.5664\/jcsm.11146","article-title":"Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study","volume":"20","author":"S Sharma","year":"2024","journal-title":"J Clin Sleep Med"},{"issue":"6","key":"pone.0321420.ref026","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/resp.12327","article-title":"Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients","volume":"19","author":"J-C Borel","year":"2014","journal-title":"Respirology"},{"issue":"2","key":"pone.0321420.ref027","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.rmed.2013.10.007","article-title":"Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis","volume":"108","author":"FM Struik","year":"2014","journal-title":"Respir Med"},{"issue":"1","key":"pone.0321420.ref028","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s12872-023-03117-x","article-title":"Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study","volume":"23","author":"A Guo","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"pone.0321420.ref029","volume-title":"The State of Literacy in America: Estimates at the Local, State, and National Levels","author":"National Institute for Literacy","year":"1990"},{"key":"pone.0321420.ref030","volume-title":"Health Literacy in Healthy People","author":"U.S. Department of Health and Human Services","year":"2030"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321420","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T17:30:44Z","timestamp":1744824644000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321420"}},"subtitle":[],"editor":[{"given":"Rabail Arif","family":"Chaudhry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,16]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0321420","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,16]]}}}