National Survey of the Use of Non-Invasive Respiratory Support for Acute Cardiogenic Pulmonary Oedema in Coronary Care Units in England

Abstract

A telephone survey was conducted to assess the provision of non-invasive respiratory support available for the treatment of acute cardiogenic pulmonary oedema in England. Of 182 acute Trusts identified, data was obtained from 153 coronary care units (CCUs) (85%). At the time the survey was undertaken, more than a quarter of these CCUs did not have the facility to provide non-invasive respiratory support (NIRS) although these therapies were provided by the hospital intensive care units (ICUs) in 100% of hospitals that were contacted. In the CCUs providing non-invasive respiratory support, less than 20% audited their services; fewer than a third had a protocol for the management of acute cardiogenic pulmonary oedema and a management plan in the event of NIRS treatment failure — ie ‘do not resuscitate’ or escalation to higher levels of care — was mandatory in only 13% of units. This survey concludes that there is suboptimal provision of NIRS across CCUs in England adding to already heavily burdened critical care services. There is also widespread lack of clinical audit and management protocols, thus the effectiveness of available services is unknown.