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Advancing Precision Respiratory Physiology in Critical Care: A 10-Year Survey of the Lung Rescue Team
Anna Caggioni1, Lorenzo Berra1,2,3, Edward A Bittner1,2
1Ms. Caggioni, Dr. Berra, Bittner, and Ribeiro De Santis Santiago are affiliated with Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Background:
Physiology-based interventions, including individualized mechanical ventilation and advanced monitoring, can improve outcomes in acute respiratory failure. A multidisciplinary team dedicated to physiologic assessment has emerged to support complex ventilatory management, yet factors influencing its recognition, understanding, and utilization within large ICU systems remain unknown.
Methods:
We conducted a cross-sectional, self-administered survey of ICU clinicians, including attending physicians, fellows, residents, advanced practice providers, nurses, and respiratory therapists, across multiple adult intensive care units within a large academic medical center. The survey assessed provider demographics, awareness, utilization, and perceptions of a specialized physiology-based Lung Rescue Team (LRT). Descriptive statistics were used to summarize responses and stratifiy results by provider role and years of experience.
Results:
Among 169 respondents, 62.7% reported awareness of the LRT, with awareness increasing with years of clinical experience. Of those aware, 93.4% reported moderate or high familiarity with the service, and 76.2% had requested at least 1 consultation in the prior year. Only 10.2% of respondents perceived the service as very well integrated into ICU workflows. The most frequently cited barriers to utilization were lack of awareness and uncertainty regarding consultation criteria, followed by workflow challenges and limited exposure to advanced physiologic monitoring. No respondents reported adverse patient outcomes related to consultation.
Conclusions:
A specialized physiology-based team is perceived as valuable and safe but may be underutilized without deliberate integration strategies. Awareness, clear consultation pathways, and workflow integration are perceived as fundamental to utilization. These findings offer practical insights for institutions seeking to develop or optimize similar multidisciplinary services to advance individualized respiratory care.
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