title: Are patients with COPD treated with NIV in accordance with national guidelines? An internal audit.
abstract: BACKGROUND
  Non-invasive ventilation (NIV) as an add-on modality to medical treatment has been recommended in national guidelines for patients acutely admitted with chronic obstructive pulmonary disorder (COPD) exacerbation and hypercapnic respiratory failure. To address concerns regarding whether NIV is used appropriately, we conducted an audit of COPD patients admitted to a university hospital in Denmark.
  
  
  METHODS
  Data from medical records were retrieved for two cohorts in 2010: 1) all patients admitted to the Medical Emergency Ward with the diagnosis of COPD, and 2) all patients receiving NIV regardless of their diagnosis at the Respiratory Ward. Demographic data and outcome of treatment were registered.
  
  
  RESULTS
  Cohort 1 comprised 804 admissions fulfilling criteria for COPD at evaluation, and of the 804 admissions, NIV was initiated in 151 (18.7%) admissions. In 42 additional cases (5.2%), initial mild respiratory acidosis was registered at admission, fulfilling criteria for NIV treatment; and, in 36 cases, the clinical status was reported as improved or not reported at all; no deaths were observed. In cohort 2, 124 admissions were registered that comprised 110 admissions with COPD and 14 without a diagnosis of COPD (of which half had a 'not-to-intubate' order). The indication for NIV treatment was met in 92.7% of the COPD admissions.
  
  
  CONCLUSIONS
  NIV was initiated in 18.8% of the COPD admissions, and in an additional 5.2%, NIV criteria were met without initiation. In 82.3% of the admissions receiving NIV, a COPD diagnosis and correct criteria for NIV treatment were met.
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Ingrid L
authors.initials: IL
authors.lastname: Titlestad
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Fanny
authors.initials: F
authors.lastname: Olsen
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Sandqvist
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Pourbazargan
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Håvard H
authors.initials: HH
authors.lastname: Fretheim
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Annmarie T
authors.initials: AT
authors.lastname: Lassen
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark ; Respiratory Research Group, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
keywords: COPD; hypercapnea; non-invasive ventilation; respiratory failure