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NATIONAL GUIDANCE LAUNCHED ON MANAGING ACUTE RESPIRATORY FAILURE
‘COULD SAVE LIVES’
New national guidelines launched today aim to help hospital-based health professionals manage
patients with life-threatening respiratory failure more effectively.
Successful implementation could prolong, and save, many lives a year across UK.
The Joint British Thoracic Society/Intensive Care Society Guidelines which have been published
online as a supplement to ‘Thorax’, provide evidence-based advice for emergency department,
respiratory and intensive care health professionals on managing acute hypercapnic respiratory
failure (AHRF) – a condition in which there is a build-up of carbon dioxide in the blood.
The condition;
 causes 50,000 hospital admissions a year
 can be fatal if not treated quickly and effectively
 complicates 20% of hospital admissions for chronic obstructive pulmonary disease (COPD),
an overall term covering a number of lung diseases - including chronic bronchitis and
emphysema
 also occurs in other lung conditions, and those associated with weak or ineffective breathing
muscles, such as Muscular Dystrophy and Motor Neurone Disease
The Guidelines are needed because national audits have shown that;
 there is variability in the delivery of non-invasive ventilation (where a close fitting face mask
helps the patient take deeper breaths) in our hospitals
 this treatment, which has revolutionised care of AHRF, is often not being given until patients
are severely unwell and often not in suitably equipped ward areas
 there is the risk that the use of non-invasive ventilation (NIV) is delaying admission to
intensive care when this is indicated
The Guideline provides clinical advice on;
 avoiding harm through the use of excessive amounts of oxygen in breathless patients
 the most effective way of providing NIV
 how to recognise when admission to the ICU is required and when invasive ventilation is
needed
 ways to make the necessary treatments more comfortable for patients
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the clinical needs for delivering a NIV service
recognition of when palliative and end of life care is needed
The Guidelines 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. They suggest that the sensitive topics of intubation and
resuscitation should be addressed with patients in advance of a medical emergency whenever
possible.
Essential elements of an effective NIV service are also outlined – these include:
 A designated lead clinician
 NIV treatment being delivered in appropriately staffed and resourced areas
 Locally developed protocols and access to expert technical support 24/7
 Regular audit and rolling staff training programmes
The Guideline authors suggest a co-ordinated effort is needed by national respiratory, intensive &
acute care organisations to improve the diagnosis, treatment and care for patients with this type of
respiratory failure and the need to lift the quality of care provided in some of our hospitals.
Dr Martin Allen, lung specialist, and Honorary Secretary of the British Thoracic Society (BTS) 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. Data
shows us that more critically ill patients might survive if they were treated in Intensive Care Units
(ICU) and we need to find the means and resources to ensure they can get appropriate access to
such care when they need it.
This Guideline provides clear advice on how to deliver the right treatment, in the right environment
at the right time to save lives. We believe that delivering clear patient pathways on AHRF will help
bring different professionals and parts of the NHS together.
The Guideline also provides a great resource for respiratory, emergency and intensive care
organisations to help create positive change in NHS practice. Although there are areas of good
practice in the NHS, we must do better to ensure patients with acute lung failure receive consistent
good quality treatment and care.’
Dr Gary Masterson, President Elect of the Intensive Care Society (ICS) said:
‘This guideline emphasises the importance of collaborative work between respiratory medicine and
critical care medicine to determine the delivery of optimal care on a case by case basis. Within this,
early joint decision-making about which patients may or may not benefit from critical admission is
vital.’
The full Guideline, is available here https://www.brit-thoracic.org.uk/guidelines-and-qualitystandards/ventilatory-management-of-acute-hypercapnic-respiratory-failure-guideline/
and a summary PowerPoint presentation is also available in the related links.
The Guidelines were produced by the British Thoracic Society/Intensive Care Society Acute
Hypercapnic Respiratory Failure Guideline Development Group. The Guideline has been endorsed by
The Royal College of Physicians, London, The College of Emergency Medicine and The Royal College
of Anaesthetists.
ENDS
For more information please contact Ed Gyde, BTS communications director on 0780 9574801;
[email protected] or John Doyle of the Intensive Care Society (ICS) on 020 7280 4350
[email protected]
Note to Editors:
The British Thoracic Society (BTS) is the UK’s professional body of respiratory specialists.
The Society seeks to improve standards of care for people who have respiratory diseases and to
support and develop those who provide that care. A registered charity, it has over 3,000 members
including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a
respiratory interest.
The Intensive Care Society (ICS) is the representative body in the UK for intensive care professionals
and patients. The organisation is dedicated to the delivery of the highest quality of critical care to
patients.
Thorax is the official journal of the British Thoracic Society and is published by the BMJ Group.