P224 Why Are We Failing in the UK in Non-Invasive Ventilation (NIV) and Acute Exacerbations of COPD (AECOPD)? Review of Our Local Practise

Introduction and Objectives Ward based NIV is proven treatment in AECOPD with type II respiratory failure with pH 7.25– 7.35.(1) Increasingly this modality is being used out with the trial evidence. The RCP audit of real world practise showed concerning results: failure or delay to deliver NIV and increaced mortality in NIV-treated patients compared to equally severe patients managed without NIV (26% vs 14%).(2) In light of these factors we reviewed our NIV use across our hospital. Did our local service need improvement? Methods We audited 4 months of emergency department admissiond in late 2011 to 2012, ward based NIV care in February-March 2011 and February-March 2012 using the BTS audit tool and critical care admissions for AECOPD from January 2010 to Decemeber 2011. Emergency Department NIV was only considered in 78% of possible patients and only given in 37%. Significant delays were seen in starting NIV; median 357 minutes (range 138–1366). Ward-based NIV In 2011 overall mortality was 33%, however patients with pH 7.25–7.35 mortality was 11%, matching the landmark trial outcomes.(1) If pH was