The effect of non-invasive ventilation on intra-abdominal pressure.

BACKGROUND: Non-invasive ventilation is a well-established treatment modality in patients with respiratory failure of different aetiologies. A previous case report described how non-invasive ventilation caused gastric distension and intra-abdominal hypertension with subsequent cardio-respiratory arrest and clinical recovery following resuscitative efforts including gastric decompression with a nasogastric tube. METHODS: The aim of this prospective multicentre observational study was to assess the effect of non-invasive ventilation on intra-abdominal pressure. Following informed consent, intra-abdominal pressure and PaCO2 were measured before and after the application of non-invasive ventilation for up to three days in critically ill patients requiring non-invasive ventilation. RESULTS: Thirty-five patients were enrolled; mean (±SD) age of 67.8 (±12.5) years, median (interquartile range) body mass index of 27.9 (24.5-30.0) kg m-2, Acute Physiology and Chronic Health Evaluation II score of 15.8 (±6.4). On admission and after 24 hours of non-invasive ventilation, intra-abdominal pressure was 11.0 (7.5-15.0) mm Hg and 11.0 (8.5-14.5) mm Hg (P = 0.82) and PaCO2 was 44.4 (±11.4) mm Hg and 51.3 (±14.3) mm Hg (P = 0.19), respectively. CONCLUSIONS: The application of non-invasive ventilation was not associated with an increase in intra-abdominal pressure over 72 hours in this small observational study. Thus, it appears that intra-abdominal pressure does not frequently increase when applying non-invasive ventilation in critically ill patients with respiratory failure.

Assessing a doctor you've rarely worked with: The use of workplace-based assessments in a busy inner city emergency department.

OBJECTIVE: Historically, end-of-term assessments for Junior Medical Officers in our ED have been completed by nominated Consultants based on varying amounts of observation in addition to feedback from other health professionals. Our hypothesis is that this system of assessment is both inconsistent and unreliable. Our objective was to increase the validity of our assessment process using workplace-based assessments linked specifically to the domains set out in the Australian Medical Council intern assessment form. METHODS: Current practice was established using an online survey. Workplace-based assessments were then performed on each junior doctor throughout the course of a term. A repeat survey at the end of term was used to audit the use of the workplace-based assessments and their effect on the adequacy of the assessments. RESULTS: Almost three quarters of our Consultants used workplace-based assessments as part of their end-of-term assessment. Overall, 80% of Consultants agreed that the Junior Medical Officers assessment process was improved when using workplace-based assessments as an adjunct. CONCLUSION: Workplace-based assessments improve the validity of end-of-term assessments for junior doctors in an ED as perceived by those performing the assessment.