Management of adult mechanically ventilated patients: A UK-wide survey

James Ward; Isis Terrington; Katie Preston; Alexander Smith; Thomas Roe; Jonathan Barnes; Emma Allen; Sandra Lima; Rebecca Cusack; Michael P W Grocott; Ahilanandan Dushianthan; South-coast Peri-operative Audit and Research Collaborative (SPARC)

doi:10.1177/17511437241292190

Management of adult mechanically ventilated patients: A UK-wide survey

J Intensive Care Soc. 2024 Oct 20:17511437241292190. doi: 10.1177/17511437241292190. Online ahead of print.

Authors

James Ward^{1

2}, Isis Terrington^{1

2}, Katie Preston^{1

2}, Alexander Smith¹, Thomas Roe^{1

2}, Jonathan Barnes³, Emma Allen⁴, Sandra Lima¹, Rebecca Cusack^{1

2

5}, Michael P W Grocott^{1

2

5}, Ahilanandan Dushianthan^{1

2

5}; South-coast Peri-operative Audit and Research Collaborative (SPARC)

Affiliations

¹ General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
² Perioperative and Critical Care Theme, Southampton National Institute of Health Research Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.
³ Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
⁴ Newcastle Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
⁵ Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.

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 (SaO₂ 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.

Collaborators: South-coast Peri-operative Audit and Research Collaborative (SPARC)Severn Trainee Anaesthetic and Critical Care Research group (STAR)Collaborative research in Anaesthesia in the Northeast (CRANE).

Keywords: Mechanical ventilation; critical care; intensive care; survey.