Respiratory Support Units must become a permanent NHS service

At the British Thoracic Society’s Winter Meeting 2021, respiratory and critical care experts explained how using advanced oxygen delivery systems (Continuous Positive Airway Pressure [CPAP]) and non-invasive ventilation (NIV)[1] on dedicated Respiratory Support Units (RSUs) during the pandemic has been crucial to save lives and preserve vital capacity in Intensive Care Units (ICUs).

Earlier this year, the British Thoracic Society and the Intensive Care Society issued joint guidance on how such units should be set-up and operated to provide best outcomes, and called for their wider roll out.

Today we are renewing this call for RSUs to be widely established and properly resourced across the NHS. RSUs will continue to help us in the response to endemic COVID-19 and bring improvement to the way we manage patients admitted to hospital with acute respiratory illnesses, especially during the winter surges of respiratory disease.

Respiratory Support Units are staffed by highly specialised multi-professional teams that offer enhanced respiratory care and monitoring to patients severely unwell with acute respiratory illnesses. They successfully treated tens of thousands of patients throughout the pandemic preventing many patients from being admitted to intensive care completely.

NHS Getting It Right First Time (GIRFT)[2] reported that hospitals that had established RSU-like services showed lower mortality during the pandemic, and in the light of their success in dealing with complex respiratory conditions, has also recommended their establishment across the NHS as a standard service.

When hospitals face the seasonal increase in emergency attendances and admissions, which we know are predominantly related to respiratory illness, RSUs will strengthen the ability of hospital teams to cope with the surge in sick respiratory patients.

They will offer the optimum specialist care for these patients; improving mortality, reducing length of stay, improving patient and relative satisfaction and preserving intensive care beds and preserving capacity in other services.

Stephen Webb, President of the Intensive Care Society said:
“Respiratory support units (RSUs) have been an essential lifeline to intensive care in helping care for patients with COVID-19 which subsequently led to both Societies issuing guidance on how such units should be set-up and operated to provide best outcomes and called for their wider roll out.

“The Intensive Care Society fully supports the renewed call for widespread RSUs to be established across the NHS. This will ensure that intensive care has this invaluable support not just through the pandemic and winter pressures, but also well into the future.”

Dr Ben Messer, author of the BTS RSU guidance, said:
“Respiratory Support Units, staffed by respiratory clinicians, have worked closely with intensive care teams during the pandemic and these units have been critical in providing care to patients with COVID-19 outside of the intensive care unit.

“Their scope is however wider than COVID-19 and if properly resourced, they will be the interface between intensive care and respiratory wards, providing safe, high quality and complex care to unwell patients with acute respiratory illnesses. RSUs are also a reminder of the close working relationship between respiratory medicine and intensive care medicine both during the pandemic and beyond.”

Professor Jon Bennett, BTS Chair said:
“Respiratory Support Units must be every hospital’s centre of excellence in respiratory care. I really think they could become one of the most positive and lasting legacies from this awful pandemic.

“The skills needed to run RSUs already exist in the NHS, however, we need to prioritise RSUs and train more expert respiratory professionals rather than simply redeploying existing staff from other essential respiratory services.”

Notes

1) Non-invasive ventilation covers a number of techniques to provide a patient with additional oxygen or help in breathing while they are conscious, and doesn’t require sedation and the use of tubes in the windpipe. It is used generally by respiratory teams for people with lung disease that require help to breathe.
2) GIRFT Clinical practice guide for improving the management of adult COVID-19 patients in secondary care, December 2020; Respiratory Medicine GIRFT Programme National Specialty Report, March 2021. Reports available on the GIRFT website.