Clinical outcomes of non-invasive ventilation in terminally ill patients receiving ward-based palliative care: a retrospective cohort study

Non-invasive ventilation (NIV) may be used in terminally ill patients with acute respiratory failure for symptom palliation and, when invasive ventilation is not pursued, as ceiling ventilatory support. However, clinical trajectories after NIV initiation in general wards remain insufficiently characterized. This study aimed to describe early symptom-related and physiological changes, NIV trajectories, and clinical outcomes in this population. This retrospective observational study included 124 terminally ill adult patients who received NIV for acute respiratory failure in general wards at a single tertiary referral center between January 2020 and December 2024. Patients were stratified by 30-day survival status into survivors ( n = 62) and non-survivors ( n = 62), and clinical characteristics, physiological trends, and outcomes were compared. Longitudinal changes were assessed using mixed-effects models, and factors associated with 30-day survival were evaluated using multivariable logistic regression. The 30-day and 90-day survival rates were 50.0% and 33.9%, respectively. Over the course of NIV treatment, pH increased and PaCO₂ decreased, while documented dyspnea and sleep tendency decreased and alertness increased. Successful NIV liberation was achieved in 41 patients (33.1%); 37 (29.8%) transitioned to home NIV, and 46 (37.1%) died during NIV support. In multivariable analysis, higher Charlson Comorbidity Index (adjusted OR 0.716, 95% CI 0.551–0.932; P = 0.013) and pneumonia as the cause of respiratory failure (adjusted OR 0.313, 95% CI 0.118–0.835; P = 0.020) were associated with lower odds of 30-day survival. Among terminally ill patients receiving NIV for acute respiratory failure in general wards, favorable symptom-related and physiological changes were observed, while clinical outcomes after NIV initiation were heterogeneous—ranging from successful liberation and transition to home NIV to death during NIV support. This heterogeneity, together with the observed symptom-related changes, may help inform clinical reassessment and shared decision-making in palliative care.