Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey

Abstract

Background

As the global outbreak of COVID-19 continues to ravage the world, it is important to understand how frontline clinicians manage ventilatory support and the various limiting factors.

Methods

An online survey composed of 32 questions was developed and validated by an international expert panel.

Results

Overall, 502 respondents from 40 countries across six continents completed the survey. The mean number (±SD) of ICU beds was 64 ± 84. The most popular initial diagnostic tools used for treatment initiation were arterial blood gas (48%) and clinical presentation (37.5%), while the national COVID-19 guidelines were the most used (61.2%). High flow nasal cannula (HFNC) (53.8%), non-invasive ventilation (NIV) (47%), and invasive mechanical ventilation (IMV) (92%) were mostly used for mild, moderate, and severe COVID-19 cases, respectively. However, only 38.8%, 56.6% and 82.9% of the respondents had standard protocols for HFNC, NIV, and IMV, respectively. The most frequently used modes of IMV and NIV were volume control (VC) (36.1%) and continuous positive airway pressure/pressure support (CPAP/PS) (40.6%). About 54% of the respondents did not adhere to the recommended, regular ventilator check interval. The majority of the respondents (85.7%) used proning with IMV, with 48.4% using it for 12–16 hours, and 46.2% had tried awake proning in combination with HFNC or NIV. Increased staff workload (45.02%), lack of trained staff (44.22%) and shortage of personal protective equipment (PPE) (42.63%) were the main barriers to COVID-19 management.

Conclusion

Our results show that general clinical practices involving ventilatory support were highly heterogeneous, with limited use of standard protocols and most frontline clinicians depending on isolated and varied management guidelines. We found increased staff workload, lack of trained staff and shortage of PPE to be the main limiting factors affecting global COVID-19 ventilatory support management.

Keywords:

• COVID-19
• ventilation
• respiratory
• clinical management
• proning
• mechanical ventilation
• NIV
• HFNC

Acknowledgments

We acknowledge all health care providers who take the time to participate in this international survey. We thank the GiViTI Italian ICU network and all the international societies that supported us in distributing and promoting the survey.

Disclosure

DDR received research equipment support (Draeger) and working as consultant in (Philips and Mallinckrodt) and non-financial support from Draeger, outside the submitted work. CO has a patent 102016000114357 with royalties paid from Intersurgical SpA. The authors report no other competing interests in this work.