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Perceptions of diagnosis and management of patients with acute respiratory distress syndrome: a survey of United Kingdom intensive care physicians

Dushianthan, Ahilanandan, Cusack, Rebecca, Chee, Nigel, Dunn, John-Oliver and Grocott, Michael P.W. (2014) Perceptions of diagnosis and management of patients with acute respiratory distress syndrome: a survey of United Kingdom intensive care physicians BMC Anesthesiology, 14, (87), pp. 1-8. (doi:10.1186/1471-2253-14-87). (PMID:25309125).

Record type: Article

Abstract

Background

Acute respiratory distress syndrome (ARDS) is a potentially devastating refractory hypoxemic illness with multi-organ involvement. Although several randomised controlled trials into ventilator and fluid management strategies have provided level 1 evidence to guide supportive therapy, there are few, established guidelines on how to manage patients with ARDS. In addition, and despite their continued use, pharmacotherapies for ARDS disease modulation have no proven benefit in improving mortality. Little is known however about the variability in diagnostic and treatment practices across the United Kingdom (UK). The aim of this survey, therefore, was to assess the use of diagnostic criteria and treatment strategies for ARDS in critical care units across the UK.

Methods

The survey questionnaire was developed and internally piloted at University Hospital Southampton NHS Foundation Trust. Following ethical approval from University of Southampton Ethics and Research Committee, a link to an online survey engine (Survey Monkey) was then placed on the Intensive Care Society (UK) website. Fellows of The Intensive Care Society were subsequently personally approached via e-mail to encourage participation. The survey was conducted over a period of 3 months.

Results

The survey received 191 responses from 125 critical care units, accounting for 11% of all registered intensive care physicians at The Intensive Care Society. The majority of the responses were from physicians managing general intensive care units (82%) and 34% of respondents preferred the American European Consensus Criteria for ARDS. There was a perceived decline in both incidence and mortality in ARDS. Primary ventilation strategies were based on ARDSnet protocols, though frequent deviations from ARDSnet positive end expiratory pressure (PEEP) recommendations (51%) were described. The majority of respondents set permissive blood gas targets (hypoxia (92%), hypercapnia (58%) and pH (90%)). The routine use of pharmacological agents is rare. Neuromuscular blockers and corticosteroids are considered occasionally and on a case-by-case basis. Routine (58%) or late (64%) tracheostomy was preferred to early tracheostomy insertion. Few centres offered routine follow-up or dedicated rehabilitation programmes following hospital discharge.

Conclusions

There is substantial variation in the diagnostic and management strategies employed for patients with ARDS across the UK. National and/or international guidelines may help to improve standardisation in the management of ARDS.

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More information

Published date: 2 October 2014
Keywords: acute respiratory distress syndrome, hypoxia, guidelines, survey

Identifiers

Local EPrints ID: 372849
URI: http://eprints.soton.ac.uk/id/eprint/372849
ISSN: 1471-2253
PURE UUID: b4ab12e4-f118-4fb1-86b4-3a98f8bd29f6

Catalogue record

Date deposited: 23 Dec 2014 12:18
Last modified: 17 Jul 2017 21:38

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Contributors

Author: Ahilanandan Dushianthan
Author: Rebecca Cusack
Author: Nigel Chee
Author: John-Oliver Dunn

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