Short Survival of Patients with Chronic Obstructive Pulmonary Disease and a Do-Not-Resuscitate Order Despite the Noninvasive Positive Pressure Ventilatory Support: A Retrospective Cohort Study in Taiwan

Background: Chronic obstructive pulmonary disease (COPD) progression leads to repeated acute exacerbations, gravely impacting patients’ quality of life. Although noninvasive positive pressure ventilation (NIPPV) reduces the work of breathing, intubation rate, and mortality in acute therapeutic care, its role and benefits in palliative care are unclear. Aims: To determine the overall survival (OS), hospital mortality, and ventilator-free survival for patients with COPD supported with NIPPV with a special emphasis on patients who signed a do-not-resuscitate (DNR) order. Design: A single-centered retrospective observational cohort study in Taiwan. Setting/Participants: In total, 209 patients with COPD with acute respiratory failure receiving NIPPV support. Results: OS was 4.8 months. For patients with a DNR, the median OS was 1.9 months, and hospital mortality was 51.0%, compared with 36.4 months and 23.3% for those without a DNR (both p < 0.001). The median ventilator-free survival periods among those liberated from ventilatory support were 3.1 and 9.0 months for patients with and without a DNR, respectively (p = 0.031). Patients with a DNR exhibited higher mortality compared with those without a DNR (adjusted hazard ratio [aHR]: 2.38; 95% confidence interval [CI]: 1.52-3.72; p < 0.001). Male sex (aHR: 2.00; 95% CI: 1.52-3.72; p < 0.001), using vasopressors (aHR: 2.03; 95% CI: 1.25-3.32; p = 0.005), and a bedridden status (aHR: 2.16; 95% CI: 1.37-3.41, p = 0.001) were associated with increased mortality. Conclusions: In patients with COPD with acute respiratory failure, those who signed a DNR order had high hospital mortality and short OS, despite NIPPV support. Therefore, providing hospice and palliative care options is essential to maximize these patients’ quality of life.