Introduction: There has been a 462% increase in acute NIV use in COPD (Chandra D et al. AJRCCM 2011) over 11 years in the United States with similar changes in the UK, where this has led to the movement of NIV provision out of critical care. We analyse temporal trends in the severity and outcomes of ward-based NIV practices. Methods: In-house NIV registry data compared: 01/08/04 -31/01/06 (Period 1) vs 01/01/11 – 30/06/12 (Period 2) at our 11-bedded ward-based NIV unit in a central England acute hospital, analysing mortality, duration of NIV and initial arterial pH. Results: AHRF: 281 episodes in Period 1 and 240 in Period 2; acute exacerbations of COPD similar proportion (about 70%) in both periods; initial arterial pH significantly lower in Period 2 (median pH 7.280 vs 7.261: see figure); mean duration of NIV was significantly higher (median length of NIV 4 days vs 6 days), in-hospital mortality similar (21.6% vs. 22.7%). Discussion: Compared to 2004, the ward-based NIV unit is treating more severely ill AHRF patients who are spending longer periods under acute NIV with no significant change in mortality. Further analysis of population characteristics, co-morbid risk factors for respiratory failure and Domiciliary NIV/Home Mechanical Ventilation practices are needed to inform health policy/strategies to deal with long term respiratory conditions.

Introduction: Longer term data on mortality of patients requiring NIV due to AHRF have been reported (Thomas A et al. ERJ 2010; 36:54. 402s). We report 1-year mortality and readmission rates of a cohort of such patients admitted to a respiratory ward-based 11-bedded physiotherapy-led NIV unit in a hospital providing acute medical services to a population of about 450000. Methods: An observational, single-centre, retrospective, follow-up study of all patients requiring NIV for AHRF (Arterial pH 7.35 and pCO2 6.0 kPa) for the first time between 01 Jan 2009 to 31 Dec 2009 was conducted. Results: Of the 163 patients treated with NIV, data was complete on 149. Mean pH 7.21; mean FEV1 21% predicted.The most common cause for admission was exacerbation of COPD 76 (51%), followed by pneumonia 22 (14.7), Primary obese morbidity 13 (8.7%), left ventricular failure 6 (4.02%) and Multifactorial AHRF 32 (21.4%); Mortality at first admission was 38/149 (25.5%) and at 24 months was 86/149 (57.7%). Readmission for AHRF peaked at 1 year, with 32.9% of patients being readmitted at least once at 12 months after first presentation. Discussion: Respiratory ward based NIV units in UK teaching hospitals tend to treat significantly more acidotic patients in real life than envisaged by the British Thoracic Society/Royal College of Physicians/Intensive Care Society 2008 guidelines. Allowing for that, short term (1-year) mortality and readmission rates remain similar to original studies on less severely acidotic AHRF patients, which probably indicates improved multidisciplinary team work and team learning.