numbers of patients receiving NIV decreased by 45.8% from 2019 to 2020 (83 vs 45 patients) with a 37.7% drop in number of COPD patients (53 vs 33). The Median (Interquartile range (IQR) time from decisive ABG to NIV setup was 61 mins (34) in 2019, which increased to 132 mins (113) in 2020 (P<0.0001). Notably, the proportion of patients meeting the BTS target decreased from 48.7% to 23.7% (P<0.0001). The number of critical care set ups decreased from 9 to 1 (P=0.0232). Moreover, the proportion

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... patients who completed NIV decreased by 68.8% (48 vs 15) (P=0.0081), with number of deaths increasing by 50% (4 vs 8) (P=0.0136). Conclusions The reduction in patient numbers receiving NIV for acidotic respiratory failure is likely due to a decrease in acute COPD exacerbations. However, NIV set up times significantly increased, reflecting the stringent COVID-19 infection control measures around aerosol generating procedures. We report a decrease in critical care set ups and an increase in deaths in 2020, highlighting excess deaths in patients receiving NIV subsequently found to be due to COVID-19. Given ongoing infection controls, global restructuring and improvement of patient flow through hospitals may be required as part of future quality improvement for decreasing response times for acute NIV set-ups.