Introduction Non-invasive ventilation (NIV) may be used for a number of specific clinical indications in the context of acute type 2 respiratory failure. Prior to October 2013, any doctor at or above ST3 level could initiate NIV on a patient if it was deemed necessary. It was noted in a number of cases the use of NIV was inappropriate and not as per the clinical guidelines.1 In October 2013 a new guideline was implemented within the Trust whereby all decisions to start patients on NIV must be discussed with and approved by the Respiratory Consultant on-call.
This study was conducted to evaluate the impact of the guideline implementation on the outcome for patients treated with NIV.
Methods Retrospective analysis of data from Inpatient NIV database of patients receiving acute NIV over a 2-year period (one year before and one year after the implementation of the new guidelines). Comparison was drawn between the data from two years for all-cause mortality and mortality specifically in those with COPD.
Results A total of 280 cases were identified over the 2-year period (140 male, 140 female). All-cause mortality was found to be lower overall in the post-intervention group (38.9% post-intervention compared to 48.3% pre-intervention). This was further analysed based on whether or not patients had COPD. Overall there was statistically significant higher mortality in non-COPD patients compared to COPD patients both before and after intervention with p values of 0.023 and 0.0096 respectively. There was significantly lower mortality in COPD patients post-intervention compared to pre-intervention (p = 0.0237). There was also lower mortality in non-COPD patients after intervention but this was not statistically significant.
Conclusion Mortality for NIV patients was considerably lower after strict implementation of the local guideline. It shows that Respiratory Consultant-led decisions enable more appropriate use of this treatment and better outcomes for patients. It also highlights the importance of education in NIV initiation for general medical doctors.
Reference 1 The use of non-invasive ventilation in the management of patients with COPD admitted to hospital with acute type 2 respiratory failure. A joint BTS/RCP London/Intensive Care Society document, 2008
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