Dushianthan Ahilanandan, Cumpstey Andrew F, Ferrari Matteo, Thomas William, Moonesinghe Ramani S, Summers Charlotte, Montgomery Hugh, Grocott Michael Pw
Critical Care Research Group, Southampton National Institute of Health Research Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.
Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
J Intensive Care Soc. 2022 Aug;23(3):285-292. doi: 10.1177/17511437211002352. Epub 2021 Mar 15.
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.
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.
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.
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.
虽然针对2019冠状病毒病（COVID-19）的管理已根据新出现的数据不断演变，但治疗此类患者仍然是一项挑战，而且许多治疗方法缺乏有力的临床证据。我们开展了一项调查，以评估对患有急性低氧性呼吸衰竭的COVID-19患者的重症监护病房（ICU）管理，并将结果与2013年针对急性呼吸窘迫综合征（ARDS）进行的类似调查数据进行比较。
问卷是在之前一项关于ARDS相关临床实践的调查基础上，使用在线电子调查引擎（Survey Monkey®）进行完善的，并鼓励所有英国重症监护医生参与。调查于2020年5月16日至2020年6月17日进行。
来自89个英国中心的137份回复。无创通气通常采用持续气道正压通气（CPAP）的形式。主要通气策略是ARDSnet方案，63%的情况偏离了其呼气末正压（PEEP）建议。与我们之前的ARDS调查类似，大多数人允许设定低氧（94%）、高碳酸血症（55%）和pH值（94%）的允许目标。抗生素的常规使用很常见，皮质类固醇也经常使用，通常是在临床试验的背景下（45%）。晚期气管切开术（>7天）更受青睐（92%）。66%的机构提供常规随访，很少有中心在出院后提供常规的专门康复计划。与ARDS调查相比，神经肌肉阻滞剂、气道压力释放通气（APRV）的使用增加，康复服务的提供有所改善。
与我们之前的ARDS调查类似，本次调查突出了因COVID-19导致急性低氧性呼吸衰竭患者所采用管理策略的差异。
