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Introduction Non-invasive ventilation (NIV) is a key intervention for acute hypercapnic respiratory failure (AHRF), with outcomes influenced by multiple factors like timing, care location, and underlying diagnosis.Aim To assess factors associated with outcomes of acute NIV in a district general hospital.Methods We retrospectively analysed data from patients who received acute NIV for AHRF between June and August 2024. Key variables included timing of NIV initiation, arterial blood gas results, setting, and diagnosis.Results 63 patients (mean age 67 years, 54% male) were included. Inpatient mortality was 16% (n=10). NIV was started in the emergency department in 68% and in the respiratory unit in 32%, with higher mortality in the latter (20% vs 14%). Median door-to-mask time was 3 hours. Early NIV (within 1 hour of decision) occurred in 73% and was associated with higher weaning rates (46%). Patients with pH <7.26 (46%) had higher mortality (21%). COPD was the most common diagnosis (63%). Patients with pulmonary oedema had the highest mortality (33%). The OSA/OHS group had a high rate of discharge with domiciliary NIV.Abstract P229 Table 1NIV Outcome by clinical variablesConclusion Our centre’s mortality rate was lower than that reported in the BTS 2017 audit. However, delayed initiation and lower initial pH were linked to poorer outcomes. Improving early recognition and reducing door-to-mask times may enhance patient outcomes.Reference British Thoracic Society. Non-invasive ventilation: Inspiring Change. National NIV Audit Report, 2017.