Comparing Nurse-Led and Physician-Led Bilevel Positive Airway Pressure Management in Hypercapnic Respiratory Failure: A Retrospective Cohort Study.

AIM: Bilevel positive airway pressure (BiPAP) management is a cornerstone in treating acute hypercapnic respiratory failure, with varying outcomes depending on the care model. This retrospective cohort study aims to compare the effectiveness of nurse-led versus physician-led BiPAP management in this context.

DESIGN

Retrospective cohort study.

METHODS

We analysed medical records of 189 patients with acute hypercapnic respiratory failure treated with BiPAP between January 2020 and December 2022. Patients were divided into nurse-led (n = 101) and physician-led (n = 88) groups based on their BiPAP management leadership. Outcomes measured included arterial blood gas (ABG) parameter improvements, intubation rates, length of hospital stay and 30-day readmission rates. Statistical analysis involved chi-squared tests, t-tests, Mann-Whitney U tests and multivariable regression to adjust for confounders.

RESULTS

Both groups demonstrated significant improvements in ABG parameters, with no significant differences between groups. The nurse-led group exhibited a lower intubation rate (9.9% vs. 21.6%, p = 0.026) and higher patient satisfaction scores (median 8 vs. 6, p < 0.001). Mortality rates, complication rates and 30-day readmission rates were similar between the groups. Multivariable logistic regression confirmed the nurse-led group had a lower likelihood of intubation (AOR: 0.401, p = 0.032) and higher patient satisfaction (AOR: 7.770, p < 0.001).

PATIENT OR PUBLIC CONTRIBUTION: Our findings indicate that nurse-led and physician-led BiPAP management strategies for acute hypercapnic respiratory failure are equally effective in terms of ABG improvement, intubation rates, hospital stay length, and readmission rates. This suggests that with adequate training and supervision, nurse-led BiPAP management can be as effective as physician-led management, offering a viable alternative in healthcare settings where physician resources are limited.