Abstract
Introduction: Although beneficial to many patients, recent data suggests significant mortality rates of up to 25% with acute Non-Invasive Ventilation (NIV) treatment [1]. It is therefore important to recognize when treatment is failing and when palliative care is appropriate.
Methods: A retrospective case note review of patients who died with type II respiratory failure due to COPD on NIV as ceiling of treatment was performed. Patients were identified at two hospital sites (University Hospital=UH) and (District General Hospital=DGH). The diagnosis, prognosis, discussion with next of kin and management plan for each patient was studied. For the DGH patients it was also recorded whether they had been prescribed “prn medications” for palliative relief of their symptoms.
Results: 16 DGH/21UH patients were identified and the results combined. Prognosis was identified as poor in 30/37 patients (81%). Discussion with next of kin took place in 30/37 patients (81%). A “care of the dying” pathway was started in 7/37 patients (19%). In the DGH patients, “prn medications” were prescribed in 7/16 patients (44%). No Cardio Respiratory Resusitation (CPR) decision was made in 2/16 patients which resulted in inappropriate CPR attempts.
Conclusion: This study highlights the deficiency in our management of end of life care in patients with end stage COPD on NIV. We need to improve our decision making with regards to CPR decisions, symptom control and appropriate palliative care.
References:
1. Roberts CM, et al. Acidosis, non-invasive ventilation and mortality in hospitalised COPD exacerbations. Thorax. 2011 Jan;66(1):43-8.
- © 2011 ERS