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SAM statement on new acute respiratory failure guidelines

The British Thoracic Society and Intensive Care Society have today published new national guidelines on the care of patients with life-threatening respiratory failure entitled Ventilatory Management of Acute Hypercapnic Respiratory Failure Guideline.

Commenting on the guidelines, Dr Nicholas Scriven, vice-president of the Society for Acute Medicine, said:

“SAM was not invited to participate in the development of these guidelines and we are extremely disappointed that they fail to acknowledge a large proportion of patients with life-threatening respiratory failure can be and are cared for appropriately on acute medical units.

“Currently around 81% of all chronic obstructive pulmonary disease (COPD) patients – who are commonly affected by acute hypercapnic respiratory failure (AHRF) – are treated initially on AMUs and 31% are cared for solely on AMUs.

“Over the time period between audits on AHRF led by the Royal College of Physicians (2008 to 2014), mortality has dropped from 7.8% to 4.3%.

“We fully support any call for improvement in the quality and delivery of care for this patient group, but it is of great concern the British Thoracic and Intensive Care societies have overlooked the relationships which already exist between emergency departments, AMUs, critical care and respiratory physicians.

“Most AMUs in the country deliver non-invasive ventilation within enhanced care beds which are appropriately staffed, monitored and supervised with ongoing collaboration between acute medicine, respiratory and critical care teams.

“We are hopeful the BTS/ICS will review the decision to omit acute medicine and amend the guidelines to ensure they accurately reflect current and successful practice in which acute internal medicine plays an integral part.”

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