{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:19:11Z","timestamp":1791854351950,"version":"4.3.4"},"reference-count":41,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2023,11,25]],"date-time":"2023-11-25T00:00:00Z","timestamp":1700870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2023,12]]},"abstract":"\n BACKGROUND:<\/jats:title>\n \n 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\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia.\n <\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n The objective of this study was to investigate the association between P\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n reduction (by using transcutaneous P\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n as an estimate for P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia. We hypothesized that reductions in P\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n 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\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n as a time-varying covariate to test the association between P\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n and all-cause mortality and when adjusting for known cofounders.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The mean \u00b1 SD age of 337 subjects was 57 \u00b1 16 years, 37% women, and 85% white. In a univariate analysis, survival probability increased with reductions in P\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n to < 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\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n . In the multivariable analysis, the subjects who had a P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n < 50 mm Hg had a reduced mortality risk of 94% between 90 and 179 d (hazard ratio [HR] 0.06, 95% CI 0.01\u20130.50), 69% between 180 and 364 d (HR 0.31, 95% CI 0.12\u20130.79), and 73% for 365\u2013730 d (HR 0.27, 95% CI 0.13\u20130.56).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n \n Reduction in P\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n 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\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4187\/respcare.10813","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T14:05:42Z","timestamp":1683122742000},"page":"1613-1622","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Lowering P\n \n CO\n 2<\/sub>\n <\/sub>\n With Noninvasive Ventilation Is Associated With Improved Survival in Chronic Hypercapnic Respiratory Failure"],"prefix":"10.1177","volume":"68","author":[{"given":"Jose Victor","family":"Jimenez","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Ackrivo","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse Y","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew W","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wassim W","family":"Labaki","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hansen-Flaschen","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C","family":"Hyzy","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,11,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2147\/OAEM.S242075"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202009-1197OC"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathophys.2003.09.003"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2012-0487OC"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202005-1687OC"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(14)70153-5"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.4451"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.22343"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201912-887OC"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.2.587"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874306401711010031"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202002-169OC"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202009-1171AG"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1159\/000488667"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27502"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2016.01.017"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-020-01586-8"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000181734.26070.26"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02011"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202008-3238CP"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2018.02.12"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/67.1.145"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7153"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1113\/JP273781"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M111.290056"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1096\/fj.09-136895"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1500150"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.2000085"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.10.014"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-0576"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2019-0061OC"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2010.153"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.21242"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1096\/fj.201901288RR"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1159\/000317138"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.06.083"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2019-214204"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2017-211466"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27457"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201311-387FR"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.04.020"}],"container-title":["Respiratory 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