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

Question Title

* 1. Your Hospital Name

Question Title

* 2. What is your grade?

Consultant

SpR/StR

Clinical/Research fellow

Other

Other (please specify)

Question Title

* 3. Is your ICU a specialist or general unit?

Question Title

* 4. How many standard ICU beds do you have?
How many hospital beds do you have?

ICU beds

Hospital beds

Question Title

* 5. What is the initial start-up mode of mandatory ventilation?

Pressure controlled ventilation

Pressue regulated/adaptive pressure ventilation with target tidal volumes

Volume controlled ventilation

Airway pressure release ventialtion (APRV)

Closed loop ventilation modes (e.g: ASV,PAV, NAVA, etc)

Synchronised Intermittent Mandatory Ventilation (SIMV)

Other (please specify)

Question Title

* 6. What is the most common ventilation mode used when a patient starts to trigger ventilation?

Pressure support ventilation (PSV)

BiLevel ventilation

Synchronised controlled mandatory ventilation (SIMV)- Pressure ventilation

Synchronised controlled mandatory ventilation (SIMV)- Volume ventilation

Airway pressure realease ventilation (APRV)

Closed-loop ventilation modes

Other (please specify)

Question Title

* 7. Do you use closed-loop ventilation modes?

Yes, Adaptive Support Ventilation (ASV)

Yes, Proportional Assist Ventilation (PAV)

Yes, INTELLiVENT-ASV

Yes, SmartCare/PS

Yes, Neurally Adjusted Ventilatory Assistance (NAVA)

Automode

Other (please specify)

Question Title

* 8. If you use closed-loop ventilation mode, roughly what proportion of patients are ventilated by this mode?

I don't use close loop ventilation mode

<10%

<25%

<50%

<75%

100%

None of the above

Question Title

* 9. Do you currently use specific guidelines/protocols/pathways for the following?

	Yes	No	Don't know
Early mobilisation	Early mobilisation Yes	Early mobilisation No	Early mobilisation Don't know
Suitability for extubation	Suitability for extubation Yes	Suitability for extubation No	Suitability for extubation Don't know
Sedation assessment and management	Sedation assessment and management Yes	Sedation assessment and management No	Sedation assessment and management Don't know
Screening for delerium and management	Screening for delerium and management Yes	Screening for delerium and management No	Screening for delerium and management Don't know
Ventilation weaning	Ventilation weaning Yes	Ventilation weaning No	Ventilation weaning Don't know
Setting PEEP	Setting PEEP Yes	Setting PEEP No	Setting PEEP Don't know

Question Title

* 10. Do you use the following measures in mechanically ventilated patients?

	Routinely as part of a bundle	Routinely but not as part of a bundle	Occasionaly	Individualised according to patient	Part of a clinical trial	Never	Not sure
Daily sedation interruption	Daily sedation interruption Routinely as part of a bundle	Daily sedation interruption Routinely but not as part of a bundle	Daily sedation interruption Occasionaly	Daily sedation interruption Individualised according to patient	Daily sedation interruption Part of a clinical trial	Daily sedation interruption Never	Daily sedation interruption Not sure
Continous ETT cuff pressure monitoing	Continous ETT cuff pressure monitoing Routinely as part of a bundle	Continous ETT cuff pressure monitoing Routinely but not as part of a bundle	Continous ETT cuff pressure monitoing Occasionaly	Continous ETT cuff pressure monitoing Individualised according to patient	Continous ETT cuff pressure monitoing Part of a clinical trial	Continous ETT cuff pressure monitoing Never	Continous ETT cuff pressure monitoing Not sure
Intermittent ETT cuff pressure monitoring	Intermittent ETT cuff pressure monitoring Routinely as part of a bundle	Intermittent ETT cuff pressure monitoring Routinely but not as part of a bundle	Intermittent ETT cuff pressure monitoring Occasionaly	Intermittent ETT cuff pressure monitoring Individualised according to patient	Intermittent ETT cuff pressure monitoring Part of a clinical trial	Intermittent ETT cuff pressure monitoring Never	Intermittent ETT cuff pressure monitoring Not sure
Closed endotrachheal suction catheter systems	Closed endotrachheal suction catheter systems Routinely as part of a bundle	Closed endotrachheal suction catheter systems Routinely but not as part of a bundle	Closed endotrachheal suction catheter systems Occasionaly	Closed endotrachheal suction catheter systems Individualised according to patient	Closed endotrachheal suction catheter systems Part of a clinical trial	Closed endotrachheal suction catheter systems Never	Closed endotrachheal suction catheter systems Not sure
Open endotracheal suction	Open endotracheal suction Routinely as part of a bundle	Open endotracheal suction Routinely but not as part of a bundle	Open endotracheal suction Occasionaly	Open endotracheal suction Individualised according to patient	Open endotracheal suction Part of a clinical trial	Open endotracheal suction Never	Open endotracheal suction Not sure
Use of subglaottic secretion drainage	Use of subglaottic secretion drainage Routinely as part of a bundle	Use of subglaottic secretion drainage Routinely but not as part of a bundle	Use of subglaottic secretion drainage Occasionaly	Use of subglaottic secretion drainage Individualised according to patient	Use of subglaottic secretion drainage Part of a clinical trial	Use of subglaottic secretion drainage Never	Use of subglaottic secretion drainage Not sure
Selective oral decontamination	Selective oral decontamination Routinely as part of a bundle	Selective oral decontamination Routinely but not as part of a bundle	Selective oral decontamination Occasionaly	Selective oral decontamination Individualised according to patient	Selective oral decontamination Part of a clinical trial	Selective oral decontamination Never	Selective oral decontamination Not sure
Selective gut decontamination	Selective gut decontamination Routinely as part of a bundle	Selective gut decontamination Routinely but not as part of a bundle	Selective gut decontamination Occasionaly	Selective gut decontamination Individualised according to patient	Selective gut decontamination Part of a clinical trial	Selective gut decontamination Never	Selective gut decontamination Not sure
Gastrointestinal stress ulcer prophylaxis	Gastrointestinal stress ulcer prophylaxis Routinely as part of a bundle	Gastrointestinal stress ulcer prophylaxis Routinely but not as part of a bundle	Gastrointestinal stress ulcer prophylaxis Occasionaly	Gastrointestinal stress ulcer prophylaxis Individualised according to patient	Gastrointestinal stress ulcer prophylaxis Part of a clinical trial	Gastrointestinal stress ulcer prophylaxis Never	Gastrointestinal stress ulcer prophylaxis Not sure

Other (please specify)

Question Title

* 11. When do you use neuromuscular agents in mechanically ventilated patients?

Routinely early stage (<48 hours) in ARDS patients

Defined by a set PaO2/FiO2 ratio (Depending on the severity)

To ameliorate ventilator dyssynchrony

During prone positioning

During bronchosopy

To control intracerebral pressure

Other (please specify)

Question Title

* 12. What is your fluid balance strategy in critically ill mechanically ventilated patients?

	Daily fluid balance targets	Preferred resuscitation fluid	If you aim negative balace, how do you achieve it?
Aims of fluid balance	Aims of fluid balance Daily fluid balance targets menu	Aims of fluid balance Preferred resuscitation fluid menu	Aims of fluid balance If you aim negative balace, how do you achieve it? menu

Comment

Question Title

* 13. What is your primary ventilation strategy in mechanically ventilated patients with Acute Hypoxemic Respiratory Failure?

Full compliance with ARDSNet protocol

Partial compliance with ARDSNet protocol with deviation from PEEP recommendations

Partial compliance with ARDSNet protocol with deviation from Tidal volume recommendations

Partial compliance with ARDSNet protocol with deviation from Fi02 recommendations

Does not use ARDSNet protocol

Airway pressure release ventilation (APRV)

Other (please specify)

Question Title

* 14. What recruitment manoeuvres do you use during ventilation of patients with acute severe hypoxemic respiratory failure?

Manual sustained inflation

Ventilator sustained inflation

Manual hyperinflation breaths

Ventilator-assisted hyperinflation breaths

Stepwise recruitement

Ventilator-assisted pressure/volume (P/V) loop recruitment

High pressure controlled ventilation

Intermittent sighs

APRV ventilation

HFOV ventialtion

I don't use any

Other (please specify)

Question Title

* 15. What variables do you use to guide your PEEP titration in mechanically ventilated patients?

ARDSNet Protocol

Degree of hypoxia

Recruitability using hysteresis via pressure-volume loop

Plateau pressure

Driving pressure

Peak airways pressure

Oesophageal pressure

End-expiratory transpulmonary pressure

Recruitability as assessed by chest ultrasound

Recruitability as assessed by CT scan

Functional imaging (Eg: electrical impedence tomography)

Other (please specify)

Question Title

* 16. Standard ventilator settings: Are tidal volume, peak pressure, plateau pressure, driving pressure or mechanical power limited?

	Tidal volume targeted	Peak pressures limited	Plateau pressure limited	Driving pressure limited	Mechanical power limited
Ventilator setting	Ventilator setting Tidal volume targeted menu	Ventilator setting Peak pressures limited menu	Ventilator setting Plateau pressure limited menu	Ventilator setting Driving pressure limited menu	Ventilator setting Mechanical power limited menu

Question Title

* 17. What are your permissive targets for all critically ill mechanically ventilated patients?

	Levels of PaC02	Levels of pH	Levels of Pa02	Levels of oxygen saturation
Permissive targets	Permissive targets Levels of PaC02 menu	Permissive targets Levels of pH menu	Permissive targets Levels of Pa02 menu	Permissive targets Levels of oxygen saturation menu

Other/comment

Question Title

* 18. What rescue measures are available at your centre for patients with severe hypoxemic respiratory failure and no improvement despite maximal ventilation?

Recruitment maneuvers

Proning

High Frequency Oscillatory Ventialtion (HFOV)

ECCO2 removal devices

Extra-Corproreal Membrane Oxygenation (ECMO)

Inhaled pulmonary vasodilators

Systemic pulmonary vasodilators

Other (please specify)

Question Title

* 19. Prone positioning. What is the indication, duration and number of cycles? Do you have dedicated prone team?

	Indication	Duration	Number of cycles	Presence of a dedicated prone team
Prone position	Prone position Indication menu	Prone position Duration menu	Prone position Number of cycles menu	Prone position Presence of a dedicated prone team menu

Question Title

* 20. Do you give continuous or bolus sedation/analgesia for mechanically ventilated patients?

Continuous

Bolus

Combination of both

Not sure

Other (please specify)

Question Title

* 21. What are the initial sedation medications for mechanically ventilated patients?

Propofol

Midazolam

Clonidine

Dexmedetomidine

Other (please specify)

Question Title

* 22. What are the initial analgesic medications for mechanically ventilated patients?

Morphine

Fentanyl

Remifentanil

Alfentanil

Ketamine

Other (please specify)

Question Title

* 23. How does the sedation levels are monitored?

Sedation scores- Richmond Agitation Sedation Scale

Sedation scores- Ramsey sedation scale

Sedation scores- others

Bispectral index (BIS)

Other (please specify)

Question Title

* 24. Do you use volatile anaesthetic agents for sedation in ICU?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 25. Who leads the initiation and management of ventilator weaning?

Nursing team

Senior medical team (Consultant/ST6 above)

All members of medical team

Physiotherapists

All of the above

Other (please specify)

Question Title

* 26. Do you use non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) and high flow nasal oxygen (HFNO) as prophylaxis during the post-extubation period?

	Routinely	Occationally	Individualised according to patient	Part of a clinical trial	Never
Non invasive ventilation	Non invasive ventilation Routinely	Non invasive ventilation Occationally	Non invasive ventilation Individualised according to patient	Non invasive ventilation Part of a clinical trial	Non invasive ventilation Never
Continuous positive airway pressure	Continuous positive airway pressure Routinely	Continuous positive airway pressure Occationally	Continuous positive airway pressure Individualised according to patient	Continuous positive airway pressure Part of a clinical trial	Continuous positive airway pressure Never
High flow nasal oxygen	High flow nasal oxygen Routinely	High flow nasal oxygen Occationally	High flow nasal oxygen Individualised according to patient	High flow nasal oxygen Part of a clinical trial	High flow nasal oxygen Never

Question Title

* 27. Regarding timing, when do you consider tracheostomy in mechanically ventilated patients?

During first 7 days of mechanical ventilation

During 7-14 days of mechanical ventilation

After 14 days of mechanical ventilation

Not sure

Comment

Question Title

* 28. Do you use the following facilities available in your unit?

	Routinely	Occationally	Rarely	Never	Don't know
Bispectral index for sedation monitoring	Bispectral index for sedation monitoring Routinely	Bispectral index for sedation monitoring Occationally	Bispectral index for sedation monitoring Rarely	Bispectral index for sedation monitoring Never	Bispectral index for sedation monitoring Don't know
Train of Four during neuomuscular blokade	Train of Four during neuomuscular blokade Routinely	Train of Four during neuomuscular blokade Occationally	Train of Four during neuomuscular blokade Rarely	Train of Four during neuomuscular blokade Never	Train of Four during neuomuscular blokade Don't know
Thoracic ultrasound for assessment of lung recruitability	Thoracic ultrasound for assessment of lung recruitability Routinely	Thoracic ultrasound for assessment of lung recruitability Occationally	Thoracic ultrasound for assessment of lung recruitability Rarely	Thoracic ultrasound for assessment of lung recruitability Never	Thoracic ultrasound for assessment of lung recruitability Don't know
Point of care ultrasonography assessing right ventricular strain	Point of care ultrasonography assessing right ventricular strain Routinely	Point of care ultrasonography assessing right ventricular strain Occationally	Point of care ultrasonography assessing right ventricular strain Rarely	Point of care ultrasonography assessing right ventricular strain Never	Point of care ultrasonography assessing right ventricular strain Don't know
Ultrasonography estimation of left atrial pressure	Ultrasonography estimation of left atrial pressure Routinely	Ultrasonography estimation of left atrial pressure Occationally	Ultrasonography estimation of left atrial pressure Rarely	Ultrasonography estimation of left atrial pressure Never	Ultrasonography estimation of left atrial pressure Don't know
Traspulmonary pressure from oesophageal balloon	Traspulmonary pressure from oesophageal balloon Routinely	Traspulmonary pressure from oesophageal balloon Occationally	Traspulmonary pressure from oesophageal balloon Rarely	Traspulmonary pressure from oesophageal balloon Never	Traspulmonary pressure from oesophageal balloon Don't know
Indirect Calorimetry for quantifying energy expenditure	Indirect Calorimetry for quantifying energy expenditure Routinely	Indirect Calorimetry for quantifying energy expenditure Occationally	Indirect Calorimetry for quantifying energy expenditure Rarely	Indirect Calorimetry for quantifying energy expenditure Never	Indirect Calorimetry for quantifying energy expenditure Don't know
Thoracic ultrasound for ventilator weaning	Thoracic ultrasound for ventilator weaning Routinely	Thoracic ultrasound for ventilator weaning Occationally	Thoracic ultrasound for ventilator weaning Rarely	Thoracic ultrasound for ventilator weaning Never	Thoracic ultrasound for ventilator weaning Don't know

Question Title

* 29. Do you routinely follow up with these patients after discharge from the hospital?

Yes

Not sure

Comment

Question Title

* 30. What rehabilitation programmes are available for patients who received mechanical ventilation after hospital discharge?

	Routine	Available	No	Don't know
Physical rehabilitation	Physical rehabilitation Routine	Physical rehabilitation Available	Physical rehabilitation No	Physical rehabilitation Don't know
Pulmonary rehabilitation	Pulmonary rehabilitation Routine	Pulmonary rehabilitation Available	Pulmonary rehabilitation No	Pulmonary rehabilitation Don't know
Nutritional therapy	Nutritional therapy Routine	Nutritional therapy Available	Nutritional therapy No	Nutritional therapy Don't know
Psychological assessment and support	Psychological assessment and support Routine	Psychological assessment and support Available	Psychological assessment and support No	Psychological assessment and support Don't know
Neuro cognitive rehabilitation	Neuro cognitive rehabilitation Routine	Neuro cognitive rehabilitation Available	Neuro cognitive rehabilitation No	Neuro cognitive rehabilitation Don't know

Comment

Question Title

* 31. Participation in research on patients requiring mechanical ventilation?

	Yes	No	Not sure
Are you currently participating in any research regarding mechanical ventilation?	Are you currently participating in any research regarding mechanical ventilation? Yes	Are you currently participating in any research regarding mechanical ventilation? No	Are you currently participating in any research regarding mechanical ventilation? Not sure
Are you able to participate in a research on patients requiring mechanical ventilation?	Are you able to participate in a research on patients requiring mechanical ventilation? Yes	Are you able to participate in a research on patients requiring mechanical ventilation? No	Are you able to participate in a research on patients requiring mechanical ventilation? Not sure
Do you have electronic database of mechanically ventilated patients?	Do you have electronic database of mechanically ventilated patients? Yes	Do you have electronic database of mechanically ventilated patients? No	Do you have electronic database of mechanically ventilated patients? Not sure
Do you regularly audit the current practice?	Do you regularly audit the current practice? Yes	Do you regularly audit the current practice? No	Do you regularly audit the current practice? Not sure

Other (please specify)

Page1 / 1

100% of survey complete.

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

Question Title

* 1. Your Hospital Name

Question Title

* 2. What is your grade?

Question Title

* 3. Is your ICU a specialist or general unit?

Question Title

* 4. How many standard ICU beds do you have?How many hospital beds do you have?

Question Title

* 5. What is the initial start-up mode of mandatory ventilation?

Question Title

* 6. What is the most common ventilation mode used when a patient starts to trigger ventilation?

Question Title

* 7. Do you use closed-loop ventilation modes?

Question Title

* 8. If you use closed-loop ventilation mode, roughly what proportion of patients are ventilated by this mode?

Question Title

* 9. Do you currently use specific guidelines/protocols/pathways for the following?

Question Title

* 10. Do you use the following measures in mechanically ventilated patients?

Question Title

* 11. When do you use neuromuscular agents in mechanically ventilated patients?

Question Title

* 12. What is your fluid balance strategy in critically ill mechanically ventilated patients?

Question Title

* 13. What is your primary ventilation strategy in mechanically ventilated patients with Acute Hypoxemic Respiratory Failure?

Question Title

* 14. What recruitment manoeuvres do you use during ventilation of patients with acute severe hypoxemic respiratory failure?

Question Title

* 15. What variables do you use to guide your PEEP titration in mechanically ventilated patients?

Question Title

* 16. Standard ventilator settings: Are tidal volume, peak pressure, plateau pressure, driving pressure or mechanical power limited?

Question Title

* 17. What are your permissive targets for all critically ill mechanically ventilated patients?

Question Title

* 18. What rescue measures are available at your centre for patients with severe hypoxemic respiratory failure and no improvement despite maximal ventilation?

Question Title

* 19. Prone positioning. What is the indication, duration and number of cycles? Do you have dedicated prone team?

Question Title

* 20. Do you give continuous or bolus sedation/analgesia for mechanically ventilated patients?

Question Title

* 21. What are the initial sedation medications for mechanically ventilated patients?

Question Title

* 22. What are the initial analgesic medications for mechanically ventilated patients?

Question Title

* 23. How does the sedation levels are monitored?

Question Title

* 24. Do you use volatile anaesthetic agents for sedation in ICU?

Question Title

* 25. Who leads the initiation and management of ventilator weaning?

Question Title

* 26. Do you use non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) and high flow nasal oxygen (HFNO) as prophylaxis during the post-extubation period?

Question Title

* 27. Regarding timing, when do you consider tracheostomy in mechanically ventilated patients?

Question Title

* 28. Do you use the following facilities available in your unit?

Question Title

* 29. Do you routinely follow up with these patients after discharge from the hospital?

Question Title

* 30. What rehabilitation programmes are available for patients who received mechanical ventilation after hospital discharge?

Question Title

* 31. Participation in research on patients requiring mechanical ventilation?

* 4. How many standard ICU beds do you have?
How many hospital beds do you have?