Management of adult mechanically ventilated patients: a UK-wide survey
Management of adult mechanically ventilated patients: a UK-wide survey
Background: Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK. Methods: All adult intensive care units in the UK were approached to participate. The questionnaire was developed with an electronic survey engine and conducted between 09/11/2023 and 01/04/2024 (Survey Monkey
®). The survey included questions on ventilator modes, settings, protocols/pathways, rescue strategies, immediate post-extubation period and follow-up. Results: There were 196 responses from 104 hospitals. The most widely adopted start-up ventilation mode was pressure-regulated volume-controlled mode. For acute hypoxaemic respiratory failure (AHRF), most of respondents reported full (39.8%) or partial compliance (58.1%) with the ARDSnet protocol, with PEEP settings being the commonest deviation. Prone positioning (99.0%), followed by recruitment manoeuvres (91.3%) were commonly used rescue measures during AHRF. APRV (55.7%), inhaled (51.3%) and systemic pulmonary vasodilators (44.1%) were also commonly used. Conservative oxygen targets (SaO
2 of 88%–92%) were commonly adopted (70.6%). As a care bundle, intermittent ETT cuff pressure monitoring was more common (65.5%) than continuous cuff pressure monitoring (20.0%). Propofol and alfentanil were the most common initial sedative and analgesia (99.5% and 56.9%) respectively. Routine volatile anaesthetic use was rare. Conclusions: Our survey has shown significant variation of practice in common but crucial elements of management of patients receiving mechanical ventilation. We hope the results in our survey highlight potential future areas of research.
Mechanical ventilation, critical care, intensive care, survey
17511437241292190
Ward, James
60f0f480-9a50-4151-93d4-77c6a3730c3c
Terrington, Isis
505d1d44-15ea-4dc9-9f96-691707c01092
Preston, Katie
7858a8f8-a96e-4f75-ba93-54dc95f4d892
Smith, Alexander
15d0eb10-6fb6-4b2c-a3bd-40e07fb12c5f
Roe, Thomas
cc2b4fda-b121-44a0-a4c0-32c3df49ffd3
Barnes, Jonathan
8ceefd75-1306-4c4c-b491-626208712e9d
Allen, Emma
577feebc-0475-4a30-aa58-f594a86822b8
Lima, Sandra
c1bc853f-d8cb-4766-9337-15b57707cce1
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Grocott, Michael P W
1e87b741-513e-4a22-be13-0f7bb344e8c2
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
South-coast Peri-operative Audit and Research Collaborative (SPARC)
Ward, James
60f0f480-9a50-4151-93d4-77c6a3730c3c
Terrington, Isis
505d1d44-15ea-4dc9-9f96-691707c01092
Preston, Katie
7858a8f8-a96e-4f75-ba93-54dc95f4d892
Smith, Alexander
15d0eb10-6fb6-4b2c-a3bd-40e07fb12c5f
Roe, Thomas
cc2b4fda-b121-44a0-a4c0-32c3df49ffd3
Barnes, Jonathan
8ceefd75-1306-4c4c-b491-626208712e9d
Allen, Emma
577feebc-0475-4a30-aa58-f594a86822b8
Lima, Sandra
c1bc853f-d8cb-4766-9337-15b57707cce1
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Grocott, Michael P W
1e87b741-513e-4a22-be13-0f7bb344e8c2
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
South-coast Peri-operative Audit and Research Collaborative (SPARC)
(2024)
Management of adult mechanically ventilated patients: a UK-wide survey.
Journal of the Intensive Care Society, .
(doi:10.1177/17511437241292190).
Abstract
Background: Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK. Methods: All adult intensive care units in the UK were approached to participate. The questionnaire was developed with an electronic survey engine and conducted between 09/11/2023 and 01/04/2024 (Survey Monkey
®). The survey included questions on ventilator modes, settings, protocols/pathways, rescue strategies, immediate post-extubation period and follow-up. Results: There were 196 responses from 104 hospitals. The most widely adopted start-up ventilation mode was pressure-regulated volume-controlled mode. For acute hypoxaemic respiratory failure (AHRF), most of respondents reported full (39.8%) or partial compliance (58.1%) with the ARDSnet protocol, with PEEP settings being the commonest deviation. Prone positioning (99.0%), followed by recruitment manoeuvres (91.3%) were commonly used rescue measures during AHRF. APRV (55.7%), inhaled (51.3%) and systemic pulmonary vasodilators (44.1%) were also commonly used. Conservative oxygen targets (SaO
2 of 88%–92%) were commonly adopted (70.6%). As a care bundle, intermittent ETT cuff pressure monitoring was more common (65.5%) than continuous cuff pressure monitoring (20.0%). Propofol and alfentanil were the most common initial sedative and analgesia (99.5% and 56.9%) respectively. Routine volatile anaesthetic use was rare. Conclusions: Our survey has shown significant variation of practice in common but crucial elements of management of patients receiving mechanical ventilation. We hope the results in our survey highlight potential future areas of research.
Text
Ward_et_al._V1.9_060924_clean_
- Accepted Manuscript
Text
Ward et al. V1.9 060924 AAM
More information
Accepted/In Press date: 20 October 2024
e-pub ahead of print date: 20 October 2024
Additional Information:
© The Intensive Care Society 2024.
Keywords:
Mechanical ventilation, critical care, intensive care, survey
Identifiers
Local EPrints ID: 497768
URI: http://eprints.soton.ac.uk/id/eprint/497768
ISSN: 1751-1437
PURE UUID: 5bb84957-2118-4fd7-9a84-21a7f05b57a4
Catalogue record
Date deposited: 30 Jan 2025 18:00
Last modified: 22 Aug 2025 02:24
Export record
Altmetrics
Contributors
Author:
James Ward
Author:
Isis Terrington
Author:
Katie Preston
Author:
Alexander Smith
Author:
Thomas Roe
Author:
Jonathan Barnes
Author:
Emma Allen
Author:
Sandra Lima
Author:
Rebecca Cusack
Author:
Ahilanandan Dushianthan
Corporate Author: South-coast Peri-operative Audit and Research Collaborative (SPARC)
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics