Intended for healthcare professionals


Every UK hospital should have a respiratory support unit, say doctors

BMJ 2021; 372 doi: (Published 17 February 2021) Cite this as: BMJ 2021;372:n466
  1. Zosia Kmietowicz
  1. The BMJ

Doctors from the British Thoracic Society are calling for the NHS to officially recognise, roll out, and fund respiratory support units across the UK.

Arrangements that resemble respiratory support units have emerged during the covid-19 pandemic to care for patients outside critical care units and are increasingly recognised as a way to deliver enhanced respiratory support to people with severe lung disease.

These units are designed to be based in respiratory wards and staffed by specialists in all aspects of acute respiratory care, in particular non-invasive ventilation. They should have access to dedicated space and oxygen infrastructure and work closely with intensive care departments.

In December the British Thoracic Society worked with the Intensive Care Society to produce guidance on respiratory care for patients with acute hypoxaemic respiratory failure associated with covid-19, tackling issues such as which patients could be looked after in non-critical care settings and the criteria for escalation to areas with higher acuity treatments.1 This covered the use of continuous positive airway pressure, high flow nasal oxygen, and non-invasive ventilation.

The same month a report from the NHS Getting it Right First Time team on what had been learnt from high performing trusts during the pandemic said that respiratory support units could reduce the burden on critical care units.2 It recommended the development of such units to provide advanced respiratory support safely outside of critical care.

Doctors think that official respiratory support units have the potential to transform respiratory care and could prove particularly useful to cope with winter pressures and the ongoing presence of endemic covid-19. When hospitals face the seasonal increase in emergency visits, which are predominantly related to respiratory illness, respiratory support units will strengthen the ability of hospital teams to meet these annual challenges, preventing the need to divert resources from inpatient and outpatient clinics and specialist services.

Jon Bennett, chair of the British Thoracic Society, said: “Respiratory support units must be every hospital’s centre of excellence in respiratory care. “It’s imperative that they are officially recognised, supported, and adequately funded so that they can outlive the covid-19 pandemic. They need robust standard operating policies and the appropriate workforce from the start, as well as funding to run them.

“We know that the skills already exist in our NHS, however the numbers do not. So we also need a commitment to increase the size of specialised respiratory workforce. I really hope these will become one of the most positive and lasting legacy from this awful pandemic.”

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