IntroductionThe approach to central airways obstruction in lung cancer varies. Having previously established benchmarking in disease prevalence, management and outcomes in 2014, we re-audited our local approach following the introduction of a dedicated interventional service.MethodNew lung cancer diagnoses in 2019 were assessed for evidence of central airways disease. Comparisons were made with our previous audit from 2014. Simple descriptive statistics were used. To identify factors associated with death, all data were combined (2014/2015 and 2019/2020). Logistic regression was used to determine the effect of age, gender, tumour type and degree of obstruction to identify independent factors associated with 60-day mortality.ResultsNo differences were seen in the clinical characteristics of people with CAO presenting in 2014/2015 and 2019. Deaths were high, with 45% of people dying within 90 days of a diagnostic CT. There was no difference in the proportion dying in 2014/2015 and 2019. Over the two time periods the proportion with CAO<50% increased (12/30 [40%] in 2014/2015 versus 18/30 [60%] in 2020; p=0.07). The proportion of people eligible for intervention and receiving intervention was unchanged between 2014/2015 and 2019 (5/16 [31%] in 2014/2015 and 3/9 [33%] in 2019). However the time to intervention improved (60.5 [interquartile range {IQR} 29.5–120.0] days in 2014/2015 and 7.0 [IQR 6.0–7.0] days in 2019; p=0.03). Although limited by the number of outcomes, after adjusting for age, gender and degree of obstruction, the odds of death was lower among people with squamous cell carcinoma compared to those with other tumour types (squamous cell cancers 8/36 [22%] vs small cell lung cancer 5/21 [24%] versus other cancers 30/74 [40%]; adjusted odds ratio [aOR] 0.40 [95%CI 0.16–1.02], aOR 0.46 [0.15–1.40]; p=0.09).ConclusionsThe impact of the interventional service did not lead to an increase in intervention, however the time to procedure improved significantly. Understanding decision making and identifying those that benefit the greatest from intervention needs further work.

Introduction Central airways obstruction (CAO) carries significant morbidity and mortality. Previous local auditing demonstrated a small number of lung cancer patients with CAO underwent interventional bronchoscopy. Following service development we prospectively re-audited. Methods We prospectively recorded cases referred to our interventional service between October 2018 and February 2020. Details on referrals of diagnoses, treatments performed and outcomes were collected. Comparisons were made with our baseline audit data from 2014. Results During the prospective audit period, 32 patients were recorded. The median[interquartile range] age was 68[59.5–73.3] years with 20/32(62.5%) being female. In 22/32(69%) cases, referral was based on index presentation. Of these, 69% were formally reported in CT scan. Symptomatic disease was noted in 23/32(72%), and 24/32(75%) had performance status of ≤2. Lung cancer was the primary diagnosis in 26/32(81%) of cases, with NSCLC-adenocarcinoma being the commonest. Rigid bronchoscopy was performed in 19/32(59%) of patients referred, and time from CT to procedure was 11[6.5–22.5] days. Debulking was the commonest intervention, while stents were placed in 3/19(16%) cases. In those patients undergoing interventional bronchoscopy, 12/19(63%) were alive at 3 months. Rigid bronchoscopy was not performed in 13/32(41%) patients. Intervention was deemed to carry too high a risk/benefit ratio in 3/13(23%) patients and 3/13(23%) patients with small cell lung cancer were referred for systemic therapy over interventional bronchoscopy. In comparison with the previous audit cohort – gender distribution, age and cancer represented were similar. More patients with CAO underwent intervention (p<0.001). Non-significant trends in improvement in time to rigid bronchoscopy and survival at 3 months were noted. Reporting of CAO on CT was unchanged. Conclusion Establishing a dedicated interventional service may impact on number of interventions, and potentially reduce time to procedure in a patient group that has a poor prognosis. However, improving recognition, standardising reporting and referral is required, as the true burden of disease remains underestimated in routine practice. Despite this, understanding reasons for not intervening need further study, as even with a pro-active team, of those referred, half of patients still did not undergo intervention.

Introduction and objectivesThe NCEPOD (2017) report on Acute Non Invasive Ventilation (NIV) underlined the failings in the provision of appropriate care for acute NIV patients in UK.1 The report highlighted that 45% of hospitals had staff supervising patients on acute NIV without defined training competency. BTS (2018) produced a NIV quality standards detailing that staff prescribing, initiating or changing NIV settings should maintain ongoing competency through training.2 Hence, we developed a pilot NIV training program at our Trust and evaluated its impact by undertaking a follow up survey.MethodsWe developed a 3 hour NIV training program comprising of lecture and a hands-on session on a NIV machine and masks. This was followed up by a competency assessment session. Participants were enrolled from different backgrounds in three different session over a period of 12 months and impact evaluation was conducted by surveying participants after at least 3 months following their training.ResultsA total of 25 participants were enrolled, comprising mainly of Medical Registrars (76%). Other participants included Core Medical Trainees, Trust Grade Doctors, Medical Consultants and Advanced Nurse Practioners. Participants were from a range of specialities, including Respiratory, Endocrinology, Acute Medicine, Geriatric and Emergency medicine. 17 completed the follow up survey. Prior NIV training was mixed, with 5 participants having no prior NIV training, and a further 4 participants stating no training within the previous 12 months. Participants had managed a mean of 7 patients on acute NIV following completion of their training. Figure 1 demonstrates that overall, this training has significantly increased their confidence to initiate and mange patients on acute NIV, as well as increased awareness of the BTS blood gas result to mask time among attendees.ConclusionsAn effective pilot NIV training was provided to ensure staffs managing acute NIV patient are trained as per BTS NIV quality statement. We aim to roll out NIV training to all other appropriate staff across trust by incorporating it as part of trust induction and competency maintenance requirement.ReferencesNCEPOD ( 2017) Acute Non-Invasive Ventilation: Inspiring Change. BTS ( 2018) Quality Standards for Non-Invasive Ventilation in Adults.