IntroductionNon-invasive ventilation (NIV) in the management of acute type II respiratory failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. The National Institute for Health and Clinical Excellence (NICE) recommend that NIV be available in all hospitals admitting patients with COPD. 1 This has led to a rapid expansion in the provision of NIV services with over 90% of UK admitting hospitals offering this intervention. The UK national audit of acute hospital COPD care in 2003, however, suggested that treatment was often applied to patients outside the existing British Thoracic Society (BTS) inclusion criteria. 2,3 This document updates the 2002 BTS guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. While there are a variety of ventilator units available most centres now use bi-level positive airways pressure (BiPAP) units and this guideline refers specifically to this form of ventilatory support although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals. Guideline development was in accordance with the AGREE principles and is summarised in the online version of this guideline (www.rcplondon. ac.uk/pubs/brochure.aspx?e=258). An extended version of this guideline encompassing service provision is available on the BTS website. Clinical contextNon-invasive ventilation, within the intensive care unit and the ward environment, has been shown in randomised controlled trials and systematic reviews to reduce intubation rate and mortality in COPD patients with decompensated respiratory acidosis (pH <7.35 and PaCO 2 >6 kPa) following immediate medical therapy. 5-14 It should therefore be considered within the first 60 minutes of hospital arrival in all patients with an acute exacerbation of COPD in whom a respiratory acidosis persists despite maximum standard medical treatment, which includes:• controlled oxygen to maintain SaO 2 88-92% • nebulised salbutamol 2.5-5 mg • nebulised ipratroprium 500 µg • prednisolone 30 mg • antibiotic agent (when indicated).A clearly documented treatment plan for NIV, including how potential failure will be dealt with and whether escalation to intubation and mechanical ventilation is indicated, should be documented in the case notes at the outset of treatment. Whenever possible the patient and carers should be involved in these discussions. Once started, patient comfort, breathing synchrony and enhanced compliance are key factors in determining outcome. Low starting pressures increase patient compliance but should be quickly adjusted upwards to achieve therapeutic effect. If effective, treatment will usually be required until the acute cause has resolved, commonly about two to three days.s CONCISE GUIDELINES

P167 Table 2 Survival within 6 months and 1 year for patients with pathological confirmation of lung cancer. Survival

Poster sessionsThorax 2012;67(Suppl 2):A1-A204 A91 studies are routinely performed early, often prior to first review in secondary care. As a result, this population may have inadequate assessment of CIN risk. To investigate this further we carried out a retrospective analysis of the monitoring of the renal function of patients with lung cancer who underwent a CT chest with contrast at a London teaching hospital. Methods A consecutive series of 100 patients diagnosed between November 2011 and January 2012 was identified using the local lung cancer registry. We examined how frequently renal function was monitored in relation to the patients' CT chest scans. Whether this was clinically adequate was decided with reference to recommendations from the Royal College of Radiologists.Results Of 30 CKD patients, 14 (47%) had appropriate precontrast bloods. Of patients identified as having diabetes (n=10), 50% had appropriate pre-contrast bloods.Of 29 patients admitted acutely, 28 (97%) had appropriate precontrast bloods.Of the 37 remaining patients, outpatients with normal renal function, 26 (70%) had appropriate pre-contrast bloods. Conclusions This study demonstrated that almost all inpatients undergoing CT chest with IV contrast had appropriate monitoring of their renal function. However, this was true of a significantly lower proportion of outpatients. Perhaps of most concern was that approximately half of those patients at the highest risk of developing contrast-induced nephropathy were monitored appropriately. We suggest that earlier CT scanning, in the interests of expediting diagnosis and treatment, could be exposing more patients to increased risk of harm associated with administration of IV contrast. References 1. Hou SH et al. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983; 74243-8. Background The widespread use of computed tomography (CT), to investigate both lung and non-lung pathology has led to the finding of increasing numbers of incidental pulmonary nodules. The BTS is currently in the process of developing guidelines on the investigation and management of pulmonary nodules, due 2013. We aim to establish current practise with pulmonary nodule follow up, including the use of low dose thin-section techniques and lung nodule volumes, both of which have been recommended to enhance patient safety and diagnostic accuracy respectively. Methods We developed a structured questionnaire in order to survey 60 hospital trusts in the London and East of England region between May-July 2012. The named lung cancer lead was emailed/ faxed with a 40% response rate. LUNG NODULE FOLLOW-UP SURVEY OF LONDON AND EAST OF ENGLAND HOSPITALS: WHAT ARE WE ACTUALLYResults All hospitals followed a local trust guideline, based partly on Fleischner Society recommendations. On discovery of an incidental lung nodule 80% of radiology departments alerted a respiratory physician and 20% the referring doctor only. 67% of hospitals reviewed patients in specialist lung cancer clinic initially, the remainder being see...