Effects of companion-based emotional care on treatment adherence and physiological-psychological outcomes in AECOPD patients with respiratory failure undergoing noninvasive ventilation: a randomized controlled trial

Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by respiratory failure often experience psychological distress and physical discomfort, which can hinder adherence to noninvasive ventilation (NIV). At present, most relevant studies have focused on the optimization of ventilation techniques, while nursing interventions targeting patients’ emotional needs remain relatively underexplored. This single-center randomized controlled trial was conducted from March 2024 to February 2025 in the Department of Respiratory and Critical Care Medicine at Fuyang Fifth People’s Hospital. After eligibility screening, 80 hospitalized patients with AECOPD requiring NIV were randomly assigned to either the routine care group (control group, n = 40) or the companion-based emotional care group (intervention group, n = 40). The 7-day nursing intervention included stepwise health education, multilevel emotional support provided by nurses trained in the study protocol, and individualized emotional support guided by repeated assessment of NIV-related discomfort and tolerance. The primary outcome was mean daily NIV duration, expressed in hours/day during the period in which NIV remained clinically prescribed. Secondary outcomes included categorical NIV adherence, arterial blood gas parameters (PaO 2 and PaCO 2 ), and Hospital Anxiety and Depression Scale scores. Following the intervention, mean daily NIV duration was significantly greater in the intervention group than in the control group ([15.25 ± 3.41] vs. [10.86 ± 5.55] hours/day; mean difference, [4.39] hours/day; 95% CI, [2.33–6.44]; P < 0.001). In the secondary categorical analysis, the total NIV adherence rate was also higher in the intervention group than in the control group (97.5% vs. 72.5%; χ 2 = 15.652, P < 0.001). The intervention group also had a significantly higher PaO 2 level than the control group (96.05 ± 8.48 vs. 68.32 ± 20.43 mmHg, t = − 7.929, P < 0.01) and a significantly lower PaCO 2 level (49.52 ± 9.35 vs. 70.05 ± 16.80 mmHg, t = 6.755, P < 0.001). In addition, the intervention group had significantly lower HADS-A (4.33 ± 2.45 vs. 8.38 ± 2.80, t = 6.883, P < 0.001) and HADS-D scores (4.89 ± 1.81 vs. 8.80 ± 2.98, t = 7.115, P < 0.001) than the control group, with within-group decreases of 5.82 and 5.14 points, respectively. Nurse-led companion-based emotional care was associated with improved NIV adherence, lower HADS scores, and more favorable PaO 2 and PaCO 2 values during the observation period. However, the arterial blood gas findings should be further validated because they might have been influenced by NIV exposure, ventilator adjustment, concurrent treatment, and clinical recovery. This trial was retrospectively registered in the Chinese Clinical Trial Registry on May 26, 2025 (ChiCTR2500103188).