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

Retrospective, single-centre design: patients were not randomised, and outcomes may reflect selection, local protocol and record accuracy rather than the management model alone. The positive findings for intubation and satisfaction were secondary; the primary blood gas outcome showed no between-group difference. Follow-up was short, mainly 24-hour blood gases and 30-day outcomes, so long-term survival, functional status and quality of life are not shown. Nurse-led care depended on specially trained respiratory nurses, a detailed local protocol and escalation to physicians or respiratory therapists, so it may not transfer to settings without that support. Exclusions removed patients with prior invasive ventilation or tracheostomy, do-not-intubate or do-not-resuscitate orders, incomplete records, or other primary diagnoses. These exclusions limit generalisability to more complex or palliative populations. Patient satisfaction was measured with a hospital-designed scale, and mortality and readmission differences were not significant.

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Do not conclude that nurse-led BiPAP is universally better or can replace physician-led care. The primary blood gas outcome showed no difference, and the lower intubation rate and higher satisfaction were secondary findings from a retrospective single-centre cohort. The nurse-led model also included a protocol, specialised training and escalation rules, so the intubation difference cannot be attributed to nurse-led status alone.