Review of acute NIV outcomes over five years in a university hospital

Abstract

Introduction: Non-Invasive Ventilation (NIV) is widely used in the management of acute hypercapnic respiratory failure (AHRF). Due to the drive to further improve quality of NIV (1), an evaluation of our clinical practice to optimise patient outcomes is essential.

Aim: To review acute NIV outcomes and adherence to national guidelines in a university hospital (2) and to determine whether there are differences in outcomes following the change to controlled oxygen ventilation used at the hospital since August 2017.

Methods: Data including patient demographics, indication for NIV, arterial blood gases, NIV pressures, length of stay and outcome, was collected prospectively from patients receiving acute NIV between 1st January 2014 – 31st December 2018.

Results: 425 patients were included of which 51% were male. The mean age was lower compared to BTS data (66 vs 72 years). COPD was the main indication for acute NIV (67%), followed by pulmonary oedema (13%), OSA (12%) and neuromuscular disorders (4%).

An increased NIV success rate of 82% was seen compared to the national mean of 68% with reduced hospital mortality of 7.6% vs BTS mean of 32%. Since starting to deliver controlled oxygen ventilation, an increased NIV success rate of 94% was seen compared to previous mean of 75%. A shorter hospital stay duration of 9 days on average was also seen versus a prior mean of 12 days.

Conclusions: Delivering controlled oxygen ventilation further improved the quality of acute NIV for the effective treatment of AHRF, leading to increased NIV success rates and lower hospital stays, and should therefore be continued, as recommended by the BTS AHRF Guidelines (2).

References:

1. Davies M. BMJ Open Resp Res 2018.

2. Davidson AC. Thorax 2016.