Abstract
Introduction
NIV is the first-line treatment for patients with acute hypercapnic respiratory failure (NIV should be “considered for all patients with a persisting respiratory acidosis after a maximum of one hour of standard medical therapy”, Royal College of Physicians, October 2008). We compare the time from initial admission to NIV mask application at two acute hospitals in central England: an NIV service in a 709-bedded hospital (Hospital 1) which appointed a Lead consultant in 2009 as per BTS recommendations and another similar NIV service without a medical lead at a 521-bedded hospital (Hospital 2).
Methods
Data from Hospital 1 taken from an acute NIV database maintained continuously since 2004; Data from Hospital 2 were drawn from NIV physiotherapy records. All patients during a 6-month period between 01/10/2010-01/04/2011 and 01/10/2011-01/04/2012 were included: 458 acute NIV episodes (9 excluded due to incomplete data).
Results
In the 2011/2012 period, 82.0% of patients at Hospital 1 received NIV within 3 hours with 69.49% of patients receiving NIV within 3 hours at Hospital 2. Hospital 1 performed similar to Hospital 2 in 2010/2011 but better in 2011/2012 compared with Hospital 2 not only in '% receiving NIV within 3 hours' but also in significantly reducing variance with a peak very close to 1 hour.
Conclusions
The service at Hospital 2 did not show any measurable improvement between 2010/2011 and 2011/2012. As demographics were very similar and the NIV physiotherapy service common to both, this difference could be a reflection on the medical leadership of the NIV service at Hospital 1 as per BTS recommendations.
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