Guideline: Ventilatory Management of Acute Hypercapnic Respiratory Failure

The British Thoracic Society/ Intensive Care Society guideline on ventilatory management of acute hypercapnic respiratory failure has been updated and published open access as a summary and full text. The guideline aims to outline the evidence of suboptimal care in acute hypercapnic respiratory failure (AHRF) in the UK, provide an overview of the evidence supporting the use of invasive and noninvasive ventilation, encourage better communication between admitting clinicians and critical care services, encourage the creation of AHRF patient pathways and improve resourcing, training, outcomes and patient experience for adults who develop acute hypercapnic respiratory failure.

The guideline includes evidence-based recommendations as well as good practice points, based on the clinical expertise of the guideline development group.

The recommendations cover the principles of mechnical ventilation, management of hypercapnic respiratory failure, weaning from invasive mechanical ventilation, care planning and delivery of care and novel therapies (extracorporeal CO₂ removal, helium/oxygen ventilation). On care delivery, the guideline recommends that noninvasive ventilation services operate under a single clinical lead with formal working links with the ICU.

See Also: Noninvasive Ventilation

The guideline aims to promote integrated planning and deliver of NIV and invasive mechanical ventilation in acute hypercapnic respiratory failure. The societies recommend the widespread introduction of an AHRF patient pathway in order to improve clinical outcomes and patient experience.

The full guideline is available from the British Thoracic Society website and published as a supplement to the April 2016 edition of Thorax.

Image credit: British Thoracic Society