No abstract

Long-term dependence on non-invasive ventilation (NIV) without time for advance care planning can result in significant complications that may require innovative management strategies. We present the case of a man who was admitted with respiratory failure and required NIV. Despite effective treatment for community acquired pneumonia, attempts to wean NIV failed. While dependent on NIV, a diagnosis of motor neuron disease was made. Time without ventilation was not tolerated and consequently complications of: facial pressure ulceration, nasal septal prolapse, inspissated secretions and failure to feed occurred. This case illustrates the severity of complications that can result from NIV dependence; however, it also details how these can be effectively managed by the hospice multidisciplinary team, with support from experts both within and external to the hospice enabling the acquisition of appropriate skills and knowledge.

needed to explore the interactions between patient, carer and clinician perceptions of non-medical devices and, ultimately whether this influences the benefits for patient self-management of chronic breathlessness.

Indications (n) chest sepsis (3), perforated viscus (2), colitis (1), bacteraemia (1), alcoholic hepatitis (1), urinary tract infection (1), unclear source (2).The median antibiotic course length was 5 days (1-14). Median WCC: 13.8X10 9 cells per litre (3.6 to 45); Median C-reactive protein: 119.1mg/L (7 to 204).Continuation of an antibiotic course was more likely if an IV cannula was in situ, and less likely when there was an alternative diagnosis.A decision to prescribe antibiotics was documented as preemptively discussed with the patient in only 1%. Conclusions 1. A significant proportion of patients that are identified as being in their last weeks of life are prescribed antibiotics 2. Decisions about antibiotic prescribing and ceilings of care were made as part of routine clinical care. This was without patient involvement and was not as a part of an ACP.3. ACP, specifically including antibiotic use should be standard practice for all patients admitted to a specialist inpatient palliative care unit.4. More research is needed, including evaluating patient acceptability.