P041 Audit findings of Bilevel Titrations performed in 2022 at a Public Sleep Laboratory

Abstract

Abstract Introduction The aim of this audit was to benchmark and grade outcomes of NIV titrations for chronic hypercapnia as per the NPPV titration task force of the AASM. Methods All NIV studies performed in 2022 were included in the audit. Titration gradings of success were defined as per the NPPV titration task force. Each change in setting was reviewed for consistency with laboratory protocols based on task force guidelines. Results 50 of 72 NIV titrations have been audited to date. Patients were mean age (56.4 years +/-17.6), 59% male, with the following pathophysiology leading to chronic hypoventilation. 46% OHS, 35% neuromuscular disease, 16% lung disease, 2% brain or spinal injury. 81% of all setting changes were consistent with laboratory protocols. Protocols were most often not followed when adjusting rise (86.2%), EPAP (82%), and ti max/min (62%). Titration grading outcomes were optimal (43%), good (14%), adequate (0%) and unacceptable (43%). Suboptimal titrations were attributed to; lack of supine REM sleep (24%), lack of sleep or any REM sleep (18%), persistent asynchrony (10%), uncontrolled obstruction (10%), or tcCO2/SpO2 not responding to treatment (38%). Patients with a primary condition of a neuromuscular disease had less suboptimal titrations (36%) compared with OHS (46%), lung disease (43%) and other conditions (50%) however were not statistically significant. Discussion Despite local titration protocols, a high number of unacceptable titrations were identified along with a high proportion of patients not responding to treatment. Further analysis to identify reasons for titration protocol deviations and treatment non-responders is required.