| Title: |
Uncertainty and decision-making in critical care: lessons from managing COVID-19 ARDS in preparation for the next pandemic. |
| Authors: |
Matsumoto, Kenki; Prowle, John R; Puthucheary, Zudin; Cecconi, Maurizio; Fazzini, Brigitta; Malcolm, Hannah; Nydahl, Peter; Osman, Magda; Santini, Alessandro; Schaller, Stefan J; Thomson, William; van den Berke, Danielle; Poll, Marcel; Stephens, Timothy |
| Publisher Information: |
BMJ; //doi.org/10.1136/bmjresp-2024-002637 |
| Publication Year: |
2025 |
| Collection: |
Apollo - University of Cambridge Repository |
| Subject Terms: |
ARDS; COVID-19; Critical Care; Humans; Uncertainty; Respiration; Artificial; Respiratory Distress Syndrome; Clinical Decision-Making; SARS-CoV-2; Decision Making; Surveys and Questionnaires; Pandemics |
| Description: |
Peer reviewed: True ; Publication status: Published ; PURPOSE: Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was an emergent syndrome that led to high volumes of critically ill ventilated patients. We explored influences on decision-making regarding management of COVID-19 ARDS mechanical ventilation to identify modifiable factors to improve preparedness for future pandemics. METHODS: A systematic review and small group interviews informed the development of an international questionnaire (UK, Italy, Germany and Netherlands) on factors influencing COVID-19 ARDS ventilation decision-making in critical care professionals. Participants ranked four themes in order of importance: disease (uncertainties around COVID-19 ARDS), contextual (cognitive strain), environmental (structural logistics) and team factors. Participants also ranked the subthemes within each theme. Thematic analysis was used to derive findings from qualitative data. Kruskal-Wallis, Mann-Whitney U and Kendall's tau were used for quantitative data analysis. RESULTS: Patient factors (comorbidities, clinical/biochemical parameters) were the most studied influences in the extant literature on decision-making; uncertainty was one of the least studied. 371 critical care professionals responded to the questionnaire. Disease uncertainty (lack of applicable guidelines, unfamiliarity with pathophysiology) was ranked as the most important influence on ventilation decision-making for COVID-19 ARDS across regions, professions and experience levels (p |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf; text/xml |
| Language: |
English |
| Relation: |
https://www.repository.cam.ac.uk/handle/1810/384703 |
| Availability: |
https://www.repository.cam.ac.uk/handle/1810/384703 |
| Accession Number: |
edsbas.F86D22C0 |
| Database: |
BASE |