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P76 Initiation of long-term non-invasive ventilation (NIV) in a specialist respiratory failure unit in the uk
  1. SJ Tetlow,
  2. PS Marino,
  3. PD Murphy,
  4. H Pattani,
  5. J Steier,
  6. N Hart
  1. Lane Fox Respiratory Unit, St Thomas’ Hospital, London, UK

Abstract

Introduction and objectives There are currently no guidelines for the provision of long-term NIV and little data into the settings and interfaces employed by different centres. Our aim was to assess long-term NIV provision in a Specialist Respiratory Failure Unit (SRFU).

Methods A retrospective observational study was performed of all patients commenced on long-term NIV by the SRFU. Data was collected from electronic patient records and technician databases on all initiations from August 2014 to January 2015.

Results Data was obtained from 113 patients. Oronasal masks were used in 87% of patients, nasal pillows in 10%, total face masks in 2% and nasal masks in 1%. Oronasal masks were used to deliver higher inspiratory positive airway pressures (IPAP) (mean ± SD 23.3 ± 5.3 cm H2O). Nasal interface use was associated with lower IPAPs (mean ± SD 12.5 ± 4.5). A relatively higher IPAP was applied at initiation to the study group (mean ± SD 22.3 ± 6.2 cm H2O) but this varied according to diagnosis; patients with obstructive sleep apnoea (OSA), chronic obstructive pulmonary disease (COPD) and motor neurone disease (MND) received a mean ± SD IPAP of 24.3 ± 5.4 cm H2O, 23.4 ± 4.2 cm H2O and 12.4 ± 3.6 cm H2O respectively.

Conclusions Oronasal masks were predominantly used reflecting the frequent application of IPAPs above 20 cm H2O as high pressures are poorly tolerated with nasal interfaces. High mean IPAPs were used in OSA and COPD patients, whilst lower IPAPs were administered to MND patients. No guidelines exist for long-term NIV use, with practice on the SRFU differing from the British Thoracic Society’s guidelines on acute NIV that recommend a “pressure target” of 20 cm H2O (Royal College Of Physicians et al. Concise Guidance to Good Practice Series, 11). However, the relevance of these guidelines to long-term NIV provision is unclear, and the lack of data has impeded the development of specific guidance. A database of patients receiving long-term NIV in the UK would facilitate research and the formulation of evidence-based best practice guidelines.

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