title: Perceptions of diagnosis and management of patients with acute respiratory distress syndrome: a survey of United Kingdom intensive care physicians.
abstract: BACKGROUND
  Acute 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  There 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.
authors.affiliation: Department of Critical Care, Portsmouth Hospitals NHS Trust Queen Alexandra Hospital, Southwick Hill Road, Cosham, PO6 3LY UK ; Critical Care Research and Anaesthesia Unit CE-93, MP-24, E-level, Centre Block, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Integrative Physiology and Critical Illness Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK.
authors.forename: Ahilanandan
authors.initials: A
authors.lastname: Dushianthan
authors.affiliation: Critical Care Research and Anaesthesia Unit CE-93, MP-24, E-level, Centre Block, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Integrative Physiology and Critical Illness Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cusack
authors.affiliation: Critical Care Unit, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Castle Lane East, Bournemouth, BH7 7DW UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Chee
authors.affiliation: Critical Care Research and Anaesthesia Unit CE-93, MP-24, E-level, Centre Block, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Integrative Physiology and Critical Illness Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK.
authors.forename: John-Oliver
authors.initials: JO
authors.lastname: Dunn
authors.affiliation: Critical Care Research and Anaesthesia Unit CE-93, MP-24, E-level, Centre Block, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Integrative Physiology and Critical Illness Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK.
authors.forename: Michael P W
authors.initials: MP
authors.lastname: Grocott
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001784:Blood Gas Analysis; D005260:Female; D005440:Fluid Therapy; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014139:Tracheostomy; D006113:United Kingdom
keywords: Acute respiratory distress syndrome; Guidelines; Hypoxia; Survey