Table 1.
Evaluation of the quality of respiratory support decision implementation.
| Item | Code | Score | Scoring criteria | Score |
|
|---|---|---|---|---|---|
| Yes | No | ||||
| Prevention of fatal situation and emergency intubation | A | 1 | Avoid fatal hypoxia or hypercapnia (SO2 < 70% or RR < 8 times/min or PaCO2 > 50 mmHg) OR Intubate and IMV in time (no >1 h when fatal hypoxia or hypercapnia happens) |
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| B | 1 | Avoid fatal respiratory distress (RR > 40 times/min or loss of consciousness or blood lactic acid >4 mmol/L) OR Intubate and IMV in time (no >1 h when fatal respiratory distress happens) |
|||
| Traditional and HFNC oxygen therapy management and intubation timing | C | 1 | FiO2 ≤ 70% to maintain the target SO2 OR Intubate and IMV in <12 h when the FiO2 > 70% |
||
| D | 1 | RR ≤ 35 times/min OR Intubate and IMV in <6 h when RR > 35 times/min |
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| NIV management and intubation time | E | 1 | FiO2 ≤ 70% to maintain the target SpO2 OR Intubate and IMV in <12 h when the FiO2 > 70% |
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| F | 1 | RR ≤ 30 times/min OR Intubate and IMV in <6 h when RR > 30 times/min |
|||
| Lung protective ventilation strategy | G | 1 | Vt ≤ 8 mL/kg (ideal body weight) | ||
| H | 1 | Pplat ≤ 30 cmH2O OR Pplat down to 30 cmH2O within 24 h when Pplat > 30 cmH2O |
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| I | 1 | Driving pressure ≤15 cmH2O OR Driving pressure down to 15 cmH2O within 24 h when driving pressure >15 cmH2O |
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| NMBAs administration | J | 1 | Avoid PaO2/FiO2 < 150 mmHg OR Using NMBAs for the IMV with PaO2/FiO2 < 150 mmHg in 48 h after intubation for 48–72 h |
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| Prone position | K | 1 | Avoid PaO2/FiO2 < 100 mmHg OR Prone position >12 h/day for IMV patients with PaO2/FiO2 < 100 mmHg |
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| Ventilation effect at 48 h after intubation by fine adjustment | L | 1 | Achieved PaO2/FiO2 increases >20% | ||
| M | 1 | Achieved PaCO2 < 48 mmHg | |||
| N | 1 | Achieved Cstat of lungs >30 mL/cmH2O | |||
| ECMO initiation and MV management during ECMO | O | 2 | Avoid ECMO OR Decision of initiating ECMO in time, including PaO2/FiO2 < 50 mmHg over 3 h or PaO2/FiO2 < 80 mmHg over 6 h Arterial blood gas pH < 7.25 and PaCO2 > 60 mmHg over 6 h, as well as RR over 35 times/min RR > 35 times/min, arterial blood gas pH < 7.2 and plateau pressure >30 cmH2O Complicated with cardiogenic shock or cardiac arrest |
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| P | 1 | Avoid ECMO OR Make right super protective ventilation strategy, including drive pressure ≤15 cmH2O and PEEP ≤ 10 cmH2O |
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| Respiratory drive management during IMV | Q | 1 | Avoid RR > 30 times/min lasts >6 h | ||
| Deduction | R | −2 | SO2 < 80% lasts >6 h during hospitalization | ||
| S | −2 | Ineffective RM were performed for more than twice; OR The duration of high PEEP that resulted in decreased lung compliance exceeded 12 h |
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| T | −2 | ECMO implementation after 7 days of IMV | |||
Cstat: Static compliance; ECMO: Extracorporeal membrane oxygenation; FiO2: Fraction of inspired oxygen; HFNC: High-flow nasal cannula; IMV: Invasive mechanical ventilation; NIV: Non-invasive ventilation; NMBAs: Neuromuscular blocking agents; PaCO2: Partial pressure of carbon dioxide; PaO2: Partial pressure of arterial oxygen; PEEP: Positive end-expiratory pressure; Pplat: Plat pressure; RM: Recruitment maneuver; RR: Respiratory rate; SO2: Oxygen saturation.