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

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.

The Physiological Basis of High-Frequency Oscillatory Ventilation and Current Evidence in Adults and Children: A Narrative Review

“…A survey of critical care specialists found that only 8% would consider HFOV as rescue while 26% would likely never utilize it ( Alhurani et al, 2016 ). Additional studies have shown HFOV use to be rare in the current era, with one reporting 4.3% of rescue cases ( Duan et al, 2017 ), another reporting 1.7% of ventilator epochs ( Jabaley et al, 2018 ), and only 10% of ICUs in the UK reporting any HFOV use ( Jha et al, 2021 ). In 2021, the use of HFOV was reported in a single center study of 48 subjects with a OI 36 and a mortality rate of 92% ( Thind et al, 2021 ).…”