How well did we do in the UK when it came to mechanical ventilation in patients with #Covid19UK? @doctorbrijpatel pulled together on 623 adults across the country to evaluate this, and to highlight learning points for the second wave https://www.medrxiv.org/content/10.1101/2020.11.10.20226688v1 1/10

Median tidal volume per kg across all mandatory breaths was 5.6 [IQR 4.7-6.6] mL/kg based on reported body weight, but 7.0 [IQR 6.0-8.4] mL/kg based on calculated ideal body weight.2/10

disease progression was different from “usual ARDS” with only 25% of patients resolving their hypoxeamia in the first week-these patients take time 3/10

44% of proned patients showed a positive oxygenation response. Responsiveness decreased the later the prone episode was initiated after intubation. Non-responsiveness was associated with worse cardiac indices, suggestive of right heart dysfunction. 4/10

76% of these patients who had moderate hypoxaemia and 46% who had severe, at any stage of admission, did not undergo prone position at all. 5/10

Over 65% of reported PEEP values were set outside +/- 1cmH2O and 53% set outside +/-2cmH2O of the ARDSNet PEEP-FiO2 tables. Changes in PEEP were widespread over the first 7 days of IMV with both increases and decreases leading to unpredictable changes in PaO2/FiO2. 6/10

Going forward, how would this data change practise? We have many experts who contributed to data collection @glenfield_aicu @GSTT_ICU @AICU_RBH @teamaccu among so many others, and would welcome their thoughts. Initially: 7/10

Now we know that COVID-19 patients commonly have significant pulmonary vascular perfusion defects, the overzealous application of PEEP with lack of responsiveness could suggest that overdistension of lung units may be an important factor to avoid in future management. 8/10

Improvements in outcomes may be generated rapidly by 1) higher quality assessment of ideal body weight. @BDAcritcare maybe you could weigh in(!) and 2)careful monitoring of P/F ratio (as opposed to Fi02 or alternatives) to ensure prone positioning is applied appropriately.9/10

Non-responsiveness to ARDS interventions should provoke a search for non-parenchymal complications of #Covid19UK. 10/11

It was an absolute privilege to be involved in this work led by @doctorbrijpatel and to watch the ICU community @ICS_updates help put this together to improve the care of our patients. 11/11