RT Journal Article
SR Electronic
T1 In or out? initiating a clinic NIV service
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P446
VO 44
IS Suppl 58
A1 Michael Newnham
A1 Helen Stone
A1 Maryam Ahmed
A1 Gail Knowles
A1 Marie Mountford
A1 Naveed Mustfa
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P446.abstract
AB IntroductionNon-invasive ventilation (NIV) has become a well-established treatment for patients with a wide variety of diagnoses and evidence of ventilatory failure. It is increasingly used for older and more functionally impaired patients. Initiating patients onto NIV as an inpatient is associated with an average length of stay of 5 days (cost £1250). Our tertiary NIV unit has recently introduced a clinic NIV initiation service for carefully selected patients who were unwilling or unable to be admitted to hospital.MethodsA retrospective study of patients undergoing clinic NIV initiation in 2012-2013. Data was collected on demography, spirometry, sniff nasal inspiratory pressure (SNIP), initial and subsequent blood gases, ventilator settings and overnight oximetry. Clinic NIV is initiated by nurse specialists with capillary blood gases and patient/carer training.Results22 patients were included. There was a range of indications: 8 severe obstructive sleep apnoea, 4 neuromuscular weakness, 3 overlap, 2 obesity hypoventilation and 5 other diagnoses. Average age was 65, with 50% male. Average FEV1 1.52 (58%), FVC 2.04 (60%), ratio 75 and SNIP -39cmH20. Average initial blood gases were pH 7.42, pO2 7.8, pCO2 6.1, HCO3 29.9 with a subsequent pCO2, of 5.6 and HCO3 of 28.3. The mean initial IPAP/EPAP settings were 15/7. There were 15 calls to the NIV help hotline with potential problems. 11 patients (50%) had documented symptomatic improvement. 20 patients remain on NIV (mean duration is 275 days). 4.5% of patients died during follow up.ConclusionsIn selected patients, clinic NIV initiation is a viable alternative to inpatient initiation, saving the equivalent of 110 bed days and £27,500. This may relieve pressure on acute NIV services.