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Guidance launched on managing acute respiratory failure in hospital


New national guidelines published this month aim to help hospital-based health professionals manage patients with life-threatening respiratory failure more effectively.

The Joint British Thoracic Society/Intensive Care Society Guidelines aim to improve the management of acute hypercapnic respiratory failure – where there is a build-up of carbon dioxide in the blood.

“This guideline provides clear advice on how to deliver the right treatment, in the right environment at the right time to save lives”

Martin Allen

Published as a supplement in the journal Thorax, they are targeted at emergency department, respiratory and intensive care health professionals.

The condition causes 50,000 hospital admissions a year and can be fatal if not treated quickly and effectively.

It complicates 20% of hospital admissions for chronic obstructive pulmonary disease and also occurs in other lung conditions, and those associated with weak or ineffective breathing muscles.

The guideline authors said the document was needed because audits have revealed variability in the delivery of non-invasive ventilation – where a close fitting face mask helps the patient take deeper breaths.

They said the treatment is often not being given until patients are severely unwell and often not in suitably equipped ward areas.

In contrast, they noted that in other circumstances there was the risk that the use of non-invasive ventilation was delaying admission to intensive care.

The guidelines cover avoiding harm through the use of excessive amounts of oxygen in breathless patients, the most effective way of providing non-invasive ventilation and how to recognise when admission to ICU is required and when invasive ventilation is needed.

Ways to make the necessary treatments more comfortable for patients are also covered by the guidance, as is the recognising when palliative and end of life care is needed.

The guideline authors noted that they “make the case” for discussing advance care plans with patients at risk of hypercapnic respiratory failure and suggest hospitals employ specific patient pathways to co-ordinate care between different specialist teams.

British Thoracic Society

Guidance launched on managing acute respiratory failure

Dr Martin Allen

They also suggest that the “sensitive topics” of intubation and resuscitation should be addressed with patients in advance of a medical emergency whenever possible.

Dr Martin Allen, lung specialist and honorary secretary of the British Thoracic Society, said: “Some patients with this type of respiratory failure are suffering, and even dying, unnecessarily because of not always receiving timely expert-delivered treatments in the right hospital setting.

“This guideline provides clear advice on how to deliver the right treatment, in the right environment at the right time to save lives,” he said.


Readers' comments (3)

  • This issue of providing NiV needs to be done by experts in the field of Redpiratory care such as Respiratory Therapist this is a very highly skilled position and nurses do not have that high level of knowledge and skills

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  • I beg to differ, all critical care trained staff, and certainly outreach nurses are more than capable of delivering this type of care

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  • I agree with comment two. There are plenty of clinical nurse specialists in respiratory who have the knowledge and expertise to mange this intervention safely and effectively. I find Ron Taylor's comment offensive to say the least

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