Many patients who are reliant on NIV have chronic and incurable diseases. These include progressive neuromuscular diseases and irreversible airways disease. Hand in hand with these diagnoses goes significant frailty. It is important when caring for these patients that we listen to their wishes at every stage. It’s especially important when they may be coming towards the end of their lives. Often at this stage people have become dependent on their ventilators and withdrawing this support must be a sensitive and pre planned procedure. There are complex ethical and emotional dynamics at play for both patients and medical professionals. This only heightens the need for meticulous planning and frank discussion.

Our survey of junior doctors in the hospital setting revealed although 85% of people had been involved with managing NIV in end of life situations, 58% did not feel confident in doing so. This has a significant effect on both the patient and the junior doctor. Patients are having unacceptable deaths due to junior doctor lack of knowledge and disempowerment.

Following review of these results we undertook the development of a guideline to allow better care during this these end of life situations. This was written with multidisciplinary team input and was subsequently reviewed by a junior doctor panel.

Once globally approved it will be introduced trust-wide and junior doctors will be re-surveyed to measure impact on practice.