Introduction BTS guidelines recommend Non-Invasive Ventilation (NIV) should take place in a clinical environment with enhanced monitoring, predicting 20% of all cases may need level 2 or 3 care.1 However, current practice varies between and within NHS organisations. A management led service change within our Trust in 2013 enabled us to test the null hypothesis that there is no significant difference in mortality of COPD patients requiring NIV on an open respiratory-led unit (level 1 care), compared to a closed, anaesthetist led Level 2 setting (PCU, Progressive Care Unit).
Methods An electronic search was performed to find patients on PCU whom received NIV between 1st January and 30th November 2014. Inclusion criteria were patients that had received NIV for COPD exacerbations solely. Data from the physician led respiratory unit between Jan–Nov 2011 was prospectively collected, and the two datasets compared.
Results In the respiratory unit 75 patients were admitted for NIV of which 54 met the criteria for inclusion in the analysis. In the PCU group 110 patients were admitted between Jan–Nov 2014. of which 55 were included for analysis.
Samples were matched in gender, with no significant difference between groups. The average age of patients treated in PCU was 69.8 years, and 74.4 years on the respiratory unit, which is statistically significant (Mann-Whitney U Test, p = 0.012). The mortality on PCU was 27.2% compared to 20.4% on the respiratory unit, which was not statistically significant. Mean pH on PCU was 7.33 compared to 7.24 on the respiratory Unit, which is statistically significant. Mean pCO2 was 10.06 on PCU, and 10.5 on the respiratory unit, which is statistically significant. Average length of stay of ward patients was 15 days, compared to 11.4 days on PCU, which was not statistically significant.
Conclusions NIV delivered on a physician-led respiratory unit was not inferior in mortality and length of stay compared with a closed, ITU-led service. Interestingly we found a significant difference in age of patients being treated with NIV, with significantly older patients receiving this on ward with no difference in overall mortality.
BTS Guidelines Management of AHRF 2016. http://www.brit-thoracic.org.uk
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