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. 2021 May;22(2):175-181.
doi: 10.1177/1751143720928895. Epub 2020 Jun 1.

A survey on the practices and capabilities in the management of respiratory failure in South East England

Abhishek Jha  1 , Francesco Vasques  2 , Barnaby Sanderson  2 , Kathleen Daly  2 , Guy Glover  2 , Nicholas Ioannou  2 , Duncan Wyncoll  2 , Peter Sherren  2 , Chris Langrish  2 , Chris Meadows  2 , Andrew Retter  2 , Richard Paul  2 , Nicholas A Barrett  2 , Luigi Camporota  2
Affiliations

A survey on the practices and capabilities in the management of respiratory failure in South East England

Abhishek Jha et al. J Intensive Care Soc. 2021 May.

Abstract

Introduction: The variability of acute respiratory distress syndrome management may affect the referral practice to severe respiratory failure centres. We described the management of acute respiratory distress syndrome in our catchment area.

Methods: An electronic survey was administered to 42 intensive care units in South-East England.

Results: Response rate was 71.4%. High-flow nasal oxygen and non-invasive ventilation were used 'often' in moderate-acute respiratory distress syndrome by 46.7% and 60%. During invasive ventilation, 90% preferred pressure control, targeting tidal volumes of 6-8 ml/kg (53.3%) or 4-6 ml/kg (46.7%). Positive end-expiratory pressure was selected by positive end-expiratory pressure/inspiratory fraction of oxygen tables (50%) or decremental positive end-expiratory pressure trials (20%). Neuro-muscular blockers were widely used, although routinely by only 3.3%. High-frequency oscillatory ventilation (10%) and inhaled nitric oxide (13.3%) were rarely used. None used oesophageal manometry. Recruitment manoeuvres were used 'often' by 26.7%. Equipment (90%) and protocols (80%) for prone position were common, with sessions mostly lasting 12-18 h.

Conclusions: Although variable, practice well reflected the available evidence. Proning was widely practiced with good availability of educational resources and protocolised care.

Keywords: Acute respiratory distress syndrome; extracorporeal membrane oxygenation; mechanical ventilation.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Practices in the management of ARDS within intensive care units in South East England. BIS: bispectral index; iNO: inhaled nitric oxide; NMB: neuromuscular blockers; PBW: predicted body weight; PP: prone position; TOF: train of four; TTE: trans-thoracic echocardiography.
Figure 2.
Figure 2.
Practices in use of respiratory therapies within intensive care units in South East England. APRV: airway pressure release ventilation; CPAP: continuous positive airway pressure; ECCO2R: extracorporeal CO2 removal; HFNC: high-flow nasal canula; HFOV: high-frequency oscillatory ventilation; ICU: intensive care unit; iNO: inhaled nitric oxide; NIV: non-invasive ventilation; NMB: neuromuscular blockers; PF:PF: Ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PaO2/FiO2); PP: prone position; RM: recruitment manoeuvre.
See this image and copyright information in PMC

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