Introduction Non-invasive ventilation (NIV) improves survival and outcomes in hypercapnic (type 2) respiratory failure. Following below average performance in a district hospital in the BTS national NIV audit, NIV delivery moved from acute medical and respiratory wards to a new hyper-acute medical unit (HAMU) providing level 1 nursing care and NIV. The unit is supervised by Respiratory Physicians and a dedicated NIV-trained nursing team, to improve outcomes for acutely unwell patients. A close working relationship with the Critical care team, and physical proximity to the Intensive care unit ensures rapid joint assessment and transfer of complex patients requiring invasive monitoring or intubation.
Aims and objectives To compare NIV success and mortality for patients with acute type 2 respiratory failure requiring NIV, before and after introduction of HAMU.
Method Data was collected for all patients in acute type 2 respiratory failure requiring NIV, for nine months before (2011–2012) and after (2012–2013) the HAMU was opened. Baseline characteristics (age, gender, performance and smoking status) were recorded. NIV success and mortality were compared and analysed. Patients requiring intubation on admission were not included.
Results Baseline characteristics in both groups were similar, and comparable to national figures. NIV was successful in 56% (28/53) before, improving to 74% (43/58) after (p < 0.05). National success rates from BTS 2013 data were 66.5%. All-cause mortality improved from 42% (22/53), to 24% (14/58) (p < 0.05). National all-cause mortality rate was 34% in 2013. Transfer to Critical care was low in both groups (1/53 pre, and 1/53 post).
Conclusions NIV success and mortality rates improved significantly following opening of the HAMU. Following establishment of the HAMU, success rates are also clearly better than national comparators for 2013. NIV delivery in a dedicated unit with highly trained nurses and dedicated respiratory medical input improves outcomes in acute Type 2 Respiratory failure.
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