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Medical Chest
Unit, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK
Correspondence to: Dr M J Doherty, Department of Respiratory Medicine, St James's Hospital, Leeds LS91, UK.
Received 23 January 1998; Returned to authors 5 March 1998; Revised version received 18 May 1998; Accepted for publication 18 May 1998
BACKGROUND
Non-invasive positive pressure
ventilation (NIPPV) has been shown to be beneficial in the treatment of
acute exacerbations of chronic obstructive pulmonary disease (COPD)
complicated by respiratory failure. A survey was undertaken to assess
the availability of NIPPV for the treatment of acute exacerbations of
COPD and to determine how NIPPV is delivered in hospitals in the UK.
METHODSA questionnaire was sent to consultants
with an interest in respiratory medicine from 268 of the hospitals
found in the BTS directory. The questionnaire enquired about the
hospital as well as the availability of NIPPV in the hospital. If NIPPV
was available in the hospital, details of implementation, staffing and
funding were determined.
RESULTSReplies to the questionnaire were received
from 98.5% of consultants. NIPPV was available in 48% of hospitals,
these hospitals tending to serve larger populations and to have more
respiratory physicians than the hospitals where NIPPV was not
available. There was considerable regional variation in the
availability of NIPPV. In hospitals where NIPPV was not available the
reason(s) were lack of consultant training in 53%, lack of other staff
training in 63%, financial in 63%, and doubt about the benefit of
NIPPV in 15% of cases. In those hospitals where NIPPV was available, clinical practice varied greatly: 68% of centres treated fewer than 20 patients a year with this form of treatment and 9% treated more than
60 patients a year. Although NIPPV was paid for completely from the
trust equipment budget in 46 hospitals (41%), other money such as
research or charitable funds were used at least partially in the other
hospitals and NIPPV was financed solely from research or charitable
funds in 41 hospitals (37%).
CONCLUSIONSEquipment for NIPPV is available in
less than half of the acute hospitals in the UK. In those in which it
is available it is generally underused. Lack of training and problems
with funding are generally given for the failure to introduce NIPPV.
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