A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure

Tayyba N Aslam; Thomas L Klitgaard; Christian A O Ahlstedt; Finn H Andersen; Michelle S Chew; Marie O Collet; Maria Cronhjort; Stine Estrup; Ole K Fossum; Shirin K Frisvold; Hans-Joerg Gillmann; Anders Granholm; Trine M Gundem; Kristin Hauss; Jacob Hollenberg; Maria E Huanca Condori; Johanna Hästbacka; Bror A Johnstad; Eric Keus; Maj-Brit N Kjaer; Pål Klepstad; Mette Krag; Reidar Kvåle; Manu L N G Malbrain; Christian S Meyhoff; Matt Morgan; Anders Møller; Carmen A Pfortmueller; Lone M Poulsen; Andrew C Robertson; Joerg C Schefold; Olav L Schjørring; Martin Siegemund; Martin I Sigurdsson; Fredrik Sjövall; Kristian Strand; Thomas Stueber; Wojciech Szczeklik; Rebecka R Wahlin; Helge L Wangberg; Karl-Andre Wian; Sine Wichmann; Kristin Hofsø; Morten H Møller; Anders Perner; Bodil S Rasmussen; Jon H Laake; SVALBARD investigators

doi:10.1111/aas.14317

A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure

Tayyba N Aslam^*, Thomas L Klitgaard, Christian A O Ahlstedt, Finn H Andersen, Michelle S Chew, Marie O Collet, Maria Cronhjort, Stine Estrup, Ole K Fossum, Shirin K Frisvold, Hans-Joerg Gillmann, Anders Granholm, Trine M Gundem, Kristin Hauss, Jacob Hollenberg, Maria E Huanca Condori, Johanna Hästbacka, Bror A Johnstad, Eric Keus, Maj-Brit N KjaerPål Klepstad, Mette Krag, Reidar Kvåle, Manu L N G Malbrain, Christian S Meyhoff, Matt Morgan, Anders Møller, Carmen A Pfortmueller, Lone M Poulsen, Andrew C Robertson, Joerg C Schefold, Olav L Schjørring, Martin Siegemund, Martin I Sigurdsson, Fredrik Sjövall, Kristian Strand, Thomas Stueber, Wojciech Szczeklik, Rebecka R Wahlin, Helge L Wangberg, Karl-Andre Wian, Sine Wichmann, Kristin Hofsø, Morten H Møller, Anders Perner, Bodil S Rasmussen, Jon H Laake, SVALBARD investigators

^*Corresponding author for this work

Abstract

BACKGROUND: When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.

METHODS: We distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice.

RESULTS: The survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF.

CONCLUSIONS: The responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	67
Issue number	10
Pages (from-to)	1383-1394
Number of pages	12
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.14317
Publication status	Published - Nov 2023

Keywords

acute hypoxaemic respiratory failure
acute respiratory distress syndrome
controlled ventilation
invasive mechanical ventilation
spontaneous ventilation
survey

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10.1111/aas.14317

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Aslam, T. N., Klitgaard, T. L., Ahlstedt, C. A. O., Andersen, F. H., Chew, M. S., Collet, M. O., Cronhjort, M., Estrup, S., Fossum, O. K., Frisvold, S. K., Gillmann, H.-J., Granholm, A., Gundem, T. M., Hauss, K., Hollenberg, J., Huanca Condori, M. E., Hästbacka, J., Johnstad, B. A., Keus, E., ... SVALBARD investigators (2023). A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure. Acta Anaesthesiologica Scandinavica, 67(10), 1383-1394. https://doi.org/10.1111/aas.14317

A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure. / Aslam, Tayyba N; Klitgaard, Thomas L; Ahlstedt, Christian A O et al.
In: Acta Anaesthesiologica Scandinavica, Vol. 67, No. 10, 11.2023, p. 1383-1394.

Research output: Contribution to journal › Journal article › Research › peer-review

Aslam, TN, Klitgaard, TL, Ahlstedt, CAO, Andersen, FH, Chew, MS, Collet, MO, Cronhjort, M, Estrup, S, Fossum, OK, Frisvold, SK, Gillmann, H-J, Granholm, A, Gundem, TM, Hauss, K, Hollenberg, J, Huanca Condori, ME, Hästbacka, J, Johnstad, BA, Keus, E, Kjaer, M-BN, Klepstad, P, Krag, M, Kvåle, R, Malbrain, MLNG, Meyhoff, CS, Morgan, M, Møller, A, Pfortmueller, CA, Poulsen, LM, Robertson, AC, Schefold, JC, Schjørring, OL, Siegemund, M, Sigurdsson, MI, Sjövall, F, Strand, K, Stueber, T, Szczeklik, W, Wahlin, RR, Wangberg, HL, Wian, K-A, Wichmann, S, Hofsø, K, Møller, MH , Perner, A, Rasmussen, BS, Laake, JH & SVALBARD investigators 2023, 'A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure', Acta Anaesthesiologica Scandinavica, vol. 67, no. 10, pp. 1383-1394. https://doi.org/10.1111/aas.14317

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title = "A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure",

abstract = "BACKGROUND: When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.METHODS: We distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice.RESULTS: The survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF.CONCLUSIONS: The responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.",

keywords = "acute hypoxaemic respiratory failure, acute respiratory distress syndrome, controlled ventilation, invasive mechanical ventilation, spontaneous ventilation, survey",

author = "Aslam, {Tayyba N} and Klitgaard, {Thomas L} and Ahlstedt, {Christian A O} and Andersen, {Finn H} and Chew, {Michelle S} and Collet, {Marie O} and Maria Cronhjort and Stine Estrup and Fossum, {Ole K} and Frisvold, {Shirin K} and Hans-Joerg Gillmann and Anders Granholm and Gundem, {Trine M} and Kristin Hauss and Jacob Hollenberg and {Huanca Condori}, {Maria E} and Johanna H{\"a}stbacka and Johnstad, {Bror A} and Eric Keus and Kjaer, {Maj-Brit N} and P{\aa}l Klepstad and Mette Krag and Reidar Kv{\aa}le and Malbrain, {Manu L N G} and Meyhoff, {Christian S} and Matt Morgan and Anders M{\o}ller and Pfortmueller, {Carmen A} and Poulsen, {Lone M} and Robertson, {Andrew C} and Schefold, {Joerg C} and Schj{\o}rring, {Olav L} and Martin Siegemund and Sigurdsson, {Martin I} and Fredrik Sj{\"o}vall and Kristian Strand and Thomas Stueber and Wojciech Szczeklik and Wahlin, {Rebecka R} and Wangberg, {Helge L} and Karl-Andre Wian and Sine Wichmann and Kristin Hofs{\o} and M{\o}ller, {Morten H} and Anders Perner and Rasmussen, {Bodil S} and Laake, {Jon H} and {SVALBARD investigators}",

note = "{\textcopyright} 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.",

year = "2023",

month = nov,

doi = "10.1111/aas.14317",

language = "English",

volume = "67",

pages = "1383--1394",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

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number = "10",

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TY - JOUR

T1 - A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure

AU - Aslam, Tayyba N

AU - Klitgaard, Thomas L

AU - Ahlstedt, Christian A O

AU - Andersen, Finn H

AU - Chew, Michelle S

AU - Collet, Marie O

AU - Cronhjort, Maria

AU - Estrup, Stine

AU - Fossum, Ole K

AU - Frisvold, Shirin K

AU - Gillmann, Hans-Joerg

AU - Granholm, Anders

AU - Gundem, Trine M

AU - Hauss, Kristin

AU - Hollenberg, Jacob

AU - Huanca Condori, Maria E

AU - Hästbacka, Johanna

AU - Johnstad, Bror A

AU - Keus, Eric

AU - Kjaer, Maj-Brit N

AU - Klepstad, Pål

AU - Krag, Mette

AU - Kvåle, Reidar

AU - Malbrain, Manu L N G

AU - Meyhoff, Christian S

AU - Morgan, Matt

AU - Møller, Anders

AU - Pfortmueller, Carmen A

AU - Poulsen, Lone M

AU - Robertson, Andrew C

AU - Schefold, Joerg C

AU - Schjørring, Olav L

AU - Siegemund, Martin

AU - Sigurdsson, Martin I

AU - Sjövall, Fredrik

AU - Strand, Kristian

AU - Stueber, Thomas

AU - Szczeklik, Wojciech

AU - Wahlin, Rebecka R

AU - Wangberg, Helge L

AU - Wian, Karl-Andre

AU - Wichmann, Sine

AU - Hofsø, Kristin

AU - Møller, Morten H

AU - Perner, Anders

AU - Rasmussen, Bodil S

AU - Laake, Jon H

AU - SVALBARD investigators

PY - 2023/11

Y1 - 2023/11

N2 - BACKGROUND: When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.METHODS: We distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice.RESULTS: The survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF.CONCLUSIONS: The responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.

AB - BACKGROUND: When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.METHODS: We distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice.RESULTS: The survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF.CONCLUSIONS: The responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.

KW - acute hypoxaemic respiratory failure

KW - acute respiratory distress syndrome

KW - controlled ventilation

KW - invasive mechanical ventilation

KW - spontaneous ventilation

KW - survey

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U2 - 10.1111/aas.14317

DO - 10.1111/aas.14317

M3 - Journal article

C2 - 37737652

SN - 0001-5172

VL - 67

SP - 1383

EP - 1394

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 10

ER -

A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure

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