RT Journal Article
SR Electronic
T1 Knowledge of non invasive ventilation in the emergency department
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2965
VO 44
IS Suppl 58
A1 Rachel Jones
A1 Andrew Stanton
A1 Mark Juniper
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P2965.abstract
AB IntroductionNon Invasive Ventilation (NIV) is being used more widely outside intensive care units (ICU) where there may not be the experience or expertise to initiate and manage situations appropriatelyAimsTo investigate doctors' knowledge of NIV in an emergency department (ED) including indications for use, appropriate set up and ongoing care.MethodsAn anonymous online questionnaire was distributed to all doctors working in ED at a UK district general hospital in February 2014. Participants were asked to identify appropriate indications for NIV and then led through a scenario of managing a patient with COPD and decompensated ventilatory failure.Results41%(15/37) of doctors responded across all grades. Self-identified confidence in managing NIV improves with seniority (5.25 vs 3.3) and past job experience in ICU (4.5 vs 2.25). Doctors were unclear about indications for NIV outside ICU/HDU. Whilst the majority (93%) correctly identified COPD exacerbations as an indicator, doctors at all grades would also use NIV for: asthma (20%), significant hypoxia (13%) and pneumothorax (7%). A quarter (27%) would start NIV without initial medical therapy. Only 40% could identify safe initial ventilatory pressures. Suggesting a value for back up rate was more problematic with 53% unable to provide any value. Only 33% could correctly alter settings while 53% of ED doctors altered both IPAP and EPAP by equal amounts.ConclusionsKnowledge of appropriate use of NIV is sub optimal across all grades in ED, and probably reflects the increasing use of a specialist intervention in the hands of non-specialists. There are a number of doctors whose use of NIV could compromise patient safety. Urgent education across all grades is needed.