Intensive care physicians’ perceptions of the diagnosis & management of patients with acute hypoxic respiratory failure associated with COVID-19: a UK based survey
Intensive care physicians’ perceptions of the diagnosis & management of patients with acute hypoxic respiratory failure associated with COVID-19: a UK based survey
Background: Whilst the management of Coronavirus disease-2019 (COVID-19) has evolved in response to the emerging data, treating such patients remains a challenge, and many treatments lack robust clinical evidence. We conducted a survey to evaluate Intensive Care Unit (ICU) management of COVID-19 patients with acute hypoxic respiratory failure and compared the results with data from a similar survey focusing on Acute Respiratory Distress Syndrome (ARDS) that was conducted in 2013.
Methods: The questionnaire was refined from a previous survey of ARDS-related clinical practice using an online electronic survey engine (Survey Monkey®) and all UK intensivists were encouraged to participate. The survey was conducted between 16/05/2020 and 17/06/2020.
Results: There were 137 responses from 89 UK centres. Non-invasive ventilation was commonly used in the form of CPAP. The primary ventilation strategy was the ARDSnet protocol, with 63% deviating from its PEEP recommendations. Similar to our previous ARDS survey, most allowed permissive targets for hypoxia (94%), hypercapnia (55%) and pH (94%). The routine use of antibiotics was common, and corticosteroids were frequently used, usually in the context of a clinical trial (45%). Late tracheostomy (>7 days) was preferred (92%). Routine follow-up was offered by 66% with few centres providing routine dedicated rehabilitation programmes following discharge. Compared to the ARDS survey, there is an increased use of neuromuscular agents, APRV ventilation and improved provision of rehabilitation services.
Conclusions: Similar to our previous ARDS survey, this survey highlights variations in the management strategies used for patients with acute hypoxic respiratory failure due to COVID-19.
COVID-19, critical care, critical illness, intensive care, survey
Dushianthan, A.
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Cumpstey, A. F.
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Ferrari, M.
75741a06-6006-436e-a725-3943397aef6a
Thomas, W.
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Moonesinghe, S. R.
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Summers, C.
00ef86a6-37b5-4f07-822b-534a5a9c161b
Montgomery, H.
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Grocott, M. P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
15 March 2021
Dushianthan, A.
013692a2-cf26-4278-80bd-9d8fcdb17751
Cumpstey, A. F.
cd040417-5e62-41d2-8640-1ec8905858a7
Ferrari, M.
75741a06-6006-436e-a725-3943397aef6a
Thomas, W.
9ae8fc0e-1b87-4b62-8e35-3dcdd6168a3c
Moonesinghe, S. R.
6ff54b33-20ca-45b4-8f5d-636cd3b55749
Summers, C.
00ef86a6-37b5-4f07-822b-534a5a9c161b
Montgomery, H.
6e2915ea-1e92-4cae-a36e-85a96b56fd12
Grocott, M. P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Dushianthan, A., Cumpstey, A. F., Ferrari, M., Thomas, W., Moonesinghe, S. R., Summers, C., Montgomery, H. and Grocott, M. P.W.
(2021)
Intensive care physicians’ perceptions of the diagnosis & management of patients with acute hypoxic respiratory failure associated with COVID-19: a UK based survey.
Journal of the Intensive Care Society.
(doi:10.1177/17511437211002352).
Abstract
Background: Whilst the management of Coronavirus disease-2019 (COVID-19) has evolved in response to the emerging data, treating such patients remains a challenge, and many treatments lack robust clinical evidence. We conducted a survey to evaluate Intensive Care Unit (ICU) management of COVID-19 patients with acute hypoxic respiratory failure and compared the results with data from a similar survey focusing on Acute Respiratory Distress Syndrome (ARDS) that was conducted in 2013.
Methods: The questionnaire was refined from a previous survey of ARDS-related clinical practice using an online electronic survey engine (Survey Monkey®) and all UK intensivists were encouraged to participate. The survey was conducted between 16/05/2020 and 17/06/2020.
Results: There were 137 responses from 89 UK centres. Non-invasive ventilation was commonly used in the form of CPAP. The primary ventilation strategy was the ARDSnet protocol, with 63% deviating from its PEEP recommendations. Similar to our previous ARDS survey, most allowed permissive targets for hypoxia (94%), hypercapnia (55%) and pH (94%). The routine use of antibiotics was common, and corticosteroids were frequently used, usually in the context of a clinical trial (45%). Late tracheostomy (>7 days) was preferred (92%). Routine follow-up was offered by 66% with few centres providing routine dedicated rehabilitation programmes following discharge. Compared to the ARDS survey, there is an increased use of neuromuscular agents, APRV ventilation and improved provision of rehabilitation services.
Conclusions: Similar to our previous ARDS survey, this survey highlights variations in the management strategies used for patients with acute hypoxic respiratory failure due to COVID-19.
Text
Dushianthan et al (2nd Revision) Final
- Accepted Manuscript
More information
e-pub ahead of print date: 15 March 2021
Published date: 15 March 2021
Keywords:
COVID-19, critical care, critical illness, intensive care, survey
Identifiers
Local EPrints ID: 448942
URI: http://eprints.soton.ac.uk/id/eprint/448942
ISSN: 1751-1437
PURE UUID: 07d62c1d-c5b7-4a4a-837c-b8ef184bdfc5
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Date deposited: 11 May 2021 17:03
Last modified: 20 Apr 2024 01:47
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Contributors
Author:
A. Dushianthan
Author:
A. F. Cumpstey
Author:
M. Ferrari
Author:
W. Thomas
Author:
S. R. Moonesinghe
Author:
C. Summers
Author:
H. Montgomery
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