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

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BMC Anesthesiology

, 14:87

Critical care


BackgroundAcute 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.

MethodsThe 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.

ResultsThe 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.

ConclusionsThere 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.

KeywordsAcute respiratory distress syndrome Hypoxia Guidelines Survey AbbreviationsAECCAmerican European Consensus Conference

ALIVEEpidemiology and outcome of acute lung injury in European intensive care units

ALTAThe albuterol for the treatment of acute lung injury

APRVAirway pressure release ventilation

ARDSAcute respiratory Distress syndrome

BALTI-2Effect of intravenous β2 agonist treatment on clinical outcomes in acute respiratory distress syndrome

ECCO2RExtracorporeal CO2 removal system

ECLSExtracorporeal lung support

HFOVHigh frequency oscillatory ventilation

ICNARCIntensive Care National Audit and Research Centre

ICSIntensive Care Society

ICUIntensive Care Unit

LISLung injury score

NMBNeuromuscular blocker

OSCARHigh-Frequency Oscillation for Acute Respiratory Distress Syndrome

OSCILLATEHigh-Frequency Oscillation in Early Acute Respiratory Distress Syndrome

PEEPPositive end-expiratory pressure

TracManEffect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-14-87 contains supplementary material, which is available to authorized users.

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


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