When should I consider referring a patient to a specialist for advanced management of mechanical ventilation?

Consider referring a patient to a specialist for advanced management of mechanical ventilation when:

• They require invasive ventilation during hospitalised exacerbations of COPD, especially if intensive care unit (ICU) admission is necessary.
• There is difficulty in weaning the patient from invasive ventilation, where non-invasive ventilation (NIV) might be considered.
• Assessment for intubation and ventilation suitability is complex, involving factors such as functional status, BMI, oxygen needs when stable, comorbidities, and previous ICU admissions, rather than relying solely on age or FEV1.
• The patient’s clinical condition is deteriorating and requires critical care expertise for advanced airway management and resuscitation skills.

Referral decisions should involve collaboration between the ward consultant and the critical care consultant to determine the appropriateness of ICU admission and advanced ventilation management.

These criteria align with NICE guidance on managing COPD exacerbations and acutely ill adults, emphasizing specialist involvement when invasive ventilation or critical care is indicated ¹,².