Abstract
Introduction
Non 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 appropriately
Aims
To investigate doctors' knowledge of NIV in an emergency department (ED) including indications for use, appropriate set up and ongoing care.
Methods
An 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.
Results
41%(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.
Conclusions
Knowledge 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.
- © 2014 ERS