Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey

Jaber S Alqahtani^{1

2}, Renata G Mendes³, Abdulelah Aldhahir^{1

4}, Daniel Rowley⁵, Mohammed D AlAhmari^{2

6}, George Ntoumenopoulos⁷, Saeed M Alghamdi^{8

9}, Jithin K Sreedharan², Yousef S Aldabayan¹⁰, Tope Oyelade¹¹, Ahmed Alrajeh¹⁰, Carlo Olivieri¹², Maher AlQuaimi¹³, Jerome Sullivan¹⁴, Mohammed A Almeshari¹⁵, Antonio Esquinas¹⁶

Affiliations

¹ UCL Respiratory, University College London, London, UK.
² Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia.
³ Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil.
⁴ Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
⁵ Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, VA, USA.
⁶ Dammam Health Network, Dammam, Saudi Arabia.
⁷ Consultant Physiotherapist, Physiotherapy Department St Vincent's Hospital Sydney, Sydney, NSW, Australia.
⁸ National Heart and Lung Institute, Imperial College London, London, UK.
⁹ Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
¹⁰ Respiratory Care, King Faisal University, Al-Ahsa, Saudi Arabia.
¹¹ UCL Institute for Liver and Digestive Health, London, UK.
¹² Emergency Department, Ospedale Sant'Andrea, Vercelli 13100, Italy.
¹³ Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
¹⁴ President, International Council for Respiratory Care, Professor Emeritus & Respiratory Care Program Director, The University of Toledo, Toledo, OH, USA.
¹⁵ Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
¹⁶ Director International NIV School, Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

PMID: 33239884
PMCID: PMC7680685
DOI: 10.2147/JMDH.S279031

Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey

Jaber S Alqahtani et al. J Multidiscip Healthc. 2020.

. 2020 Nov 18:13:1635-1648.

doi: 10.2147/JMDH.S279031. eCollection 2020.

Authors

Affiliations

¹ UCL Respiratory, University College London, London, UK.
² Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia.
³ Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil.
⁴ Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
⁵ Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, VA, USA.
⁶ Dammam Health Network, Dammam, Saudi Arabia.
⁷ Consultant Physiotherapist, Physiotherapy Department St Vincent's Hospital Sydney, Sydney, NSW, Australia.
⁸ National Heart and Lung Institute, Imperial College London, London, UK.
⁹ Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
¹⁰ Respiratory Care, King Faisal University, Al-Ahsa, Saudi Arabia.
¹¹ UCL Institute for Liver and Digestive Health, London, UK.
¹² Emergency Department, Ospedale Sant'Andrea, Vercelli 13100, Italy.
¹³ Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
¹⁴ President, International Council for Respiratory Care, Professor Emeritus & Respiratory Care Program Director, The University of Toledo, Toledo, OH, USA.
¹⁵ Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
¹⁶ Director International NIV School, Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

PMID: 33239884
PMCID: PMC7680685
DOI: 10.2147/JMDH.S279031

Abstract

Background: As the global outbreak of COVID-19 continues to ravage the world, it is important to understand how frontline clinicians manage ventilatory support and the various limiting factors.

Methods: An online survey composed of 32 questions was developed and validated by an international expert panel.

Results: Overall, 502 respondents from 40 countries across six continents completed the survey. The mean number (±SD) of ICU beds was 64 ± 84. The most popular initial diagnostic tools used for treatment initiation were arterial blood gas (48%) and clinical presentation (37.5%), while the national COVID-19 guidelines were the most used (61.2%). High flow nasal cannula (HFNC) (53.8%), non-invasive ventilation (NIV) (47%), and invasive mechanical ventilation (IMV) (92%) were mostly used for mild, moderate, and severe COVID-19 cases, respectively. However, only 38.8%, 56.6% and 82.9% of the respondents had standard protocols for HFNC, NIV, and IMV, respectively. The most frequently used modes of IMV and NIV were volume control (VC) (36.1%) and continuous positive airway pressure/pressure support (CPAP/PS) (40.6%). About 54% of the respondents did not adhere to the recommended, regular ventilator check interval. The majority of the respondents (85.7%) used proning with IMV, with 48.4% using it for 12-16 hours, and 46.2% had tried awake proning in combination with HFNC or NIV. Increased staff workload (45.02%), lack of trained staff (44.22%) and shortage of personal protective equipment (PPE) (42.63%) were the main barriers to COVID-19 management.

Conclusion: Our results show that general clinical practices involving ventilatory support were highly heterogeneous, with limited use of standard protocols and most frontline clinicians depending on isolated and varied management guidelines. We found increased staff workload, lack of trained staff and shortage of PPE to be the main limiting factors affecting global COVID-19 ventilatory support management.

Keywords: COVID-19; HFNC; NIV; clinical management; mechanical ventilation; proning; respiratory; ventilation.

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Conflict of interest statement

DDR received research equipment support (Draeger) and working as consultant in (Philips and Mallinckrodt) and non-financial support from Draeger, outside the submitted work. CO has a patent 102016000114357 with royalties paid from Intersurgical SpA. The authors report no other competing interests in this work.

Figures

**Figure 1**
Percentage of responders per country.

**Figure 2**
Academic degrees per continent.

**Figure 3**
Formal training in MV per continent.

**Figure 4**
Mean ICU beds per continent.

**Figure 5**
Total beds per hospital in all continents.

**Figure 6**
Barriers and limitations of COVID-19 clinical management. (A) represents the (%) of barriers and limitations per continent. (B) represents the (%) of barriers and limitations corresponding to the overall responses.

See this image and copyright information in PMC

References

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Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey

Affiliations

Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials