Introduction Non Invasive Ventilation (NIV) is being used more widely in acute areas by medical staff with varied training and experience in initiation and ongoing management of ventilatory failure.
Aims To investigate doctors’ knowledge of NIV in an emergency department (ED) and general medical wards, specifically indications for use, appropriate set up and ongoing care.
Methods An anonymous online and written questionnaire was distributed to all doctors working in general medicine and in the ED at a UK district general hospital in Spring 2014. Participants were asked to identify appropriate indications for NIV and then led through a scenario of managing a patient with COPD and decompensated ventilatory failure.
Results 40/116 (34%) of doctors responded across all grades. On a 6-point scale. self-identified confidence in managing NIV improves with seniority (5.2 (ST3+) vs 3.3 (FY1-ST2)) and past job experience in ICU (4.1 vs 3.6). Doctors were unclear about indications for NIV outside ICU/HDU. Whilst the majority (95%) correctly identified COPD exacerbations as an indicator, doctors at all grades would also use NIV for: asthma (10%), significant hypoxia (10%) and pneumothorax (3%). A fifth (18%) would start NIV without initial medical therapy. Only 55% (22/40) could identify appropriate initial ventilatory pressures (initial IPAP range 4–16, initial EPAP range 4–16). Suggesting a value for back up rate was more problematic with 43% (17/40) unable to provide any value and 9/23 (39%) suggesting an inappropriate value (range 8–18). Only 55% (22/40) could correctly alter settings while 23% (9/40) of doctors altered both IPAP and EPAP by equal amounts. 50% (4/8) ED/medical registrars could not alter settings correctly
Conclusions Knowledge of appropriate use of NIV is sub optimal across all grades working in the ED and general medicine in our institution, and probably reflects the increasing use of a specialist intervention in the hands of non-specialists. There are a number of doctors whose use of NIV could compromise patient safety. Urgent education across all grades is needed alongside review of how NIV is delivered in the DGH setting.
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