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Advanced respiratory care techniques in a severe adult respiratory failure unit


Outcome is improved when patients with severe adult respiratory distress syndrome are transferred to an extracorporeal membrane oxygenation (ECMO)-capable unit [1]. Not all patients transferred require ECMO, and this service evaluation examines which techniques are utilised in patients who ultimately do not require ECMO.


All patients transferred to the Severe Adult Respiratory Failure (SARF) unit between April 2012 and April 2013 for advanced respiratory care who did not require ECMO, identified from the ECMO database, underwent retrospective notes' review to identify the advanced respiratory techniques performed at the SARF unit and the base hospital.


Ten patients were admitted for advanced respiratory care who did not require ECMO. Eight patients had community-acquired pneumonia, one had an inhalational injury and one had a previously undiagnosed cardiac sarcoma. The techniques utilised in the SARF unit and base hospital are shown in Figure 1. Nine patients were discharged from the SARF unit alive (90%).

Figure 1
figure 1

Frequency of interventions in the base hospital (BH) and SARF centre.


A negative fluid balance and targeting higher haemoglobin are more frequently achieved in a SARF unit. Further studies are required to fully elucidate the advanced respiratory care techniques undertaken at specialist SARF units.


  1. Peek GJ, Mugford M, Tiruvoipati R, et al.: Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009, 374: 1351-1363. 10.1016/S0140-6736(09)61069-2

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Rafiq, D., Needham, A., Porter, R. et al. Advanced respiratory care techniques in a severe adult respiratory failure unit. Crit Care 18 (Suppl 1), P314 (2014).

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