Acute Respiratory Failure Consultation Process
Acute Respiratory Failure Consultation Process
Expert Consultation for Patients with Severe Respiratory Failure
University of Utah Health provides 24/7 access to Pulmonary and Critical Care physicians for consultation regarding patients with acute respiratory failure, advanced respiratory support needs, consideration for venovenous extracorporeal membrane oxygenation (VV ECMO), and transfer to a higher level of care.
WHEN TO CALL
Contact the University of Utah Transfer Center for:
- Acute respiratory failure consultation
- Advanced ventilator management support
- Escalating respiratory support needs
- VV ECMO candidacy evaluation
- Transfer consideration for advanced respiratory failure management
- Consultation regarding potential lung transplant candidacy in the setting of acute-on-chronic respiratory failure, when appropriate
WHat to Expect
Immediate Specialist Access
When you contact the Transfer Center, your call will be connected with the University of Utah Pulmonary Critical Care physician (Medical ICU Attending) on call for acute respiratory failure consultations.
The consulting physician will:
- Review the patient's clinical status
- Discuss current therapies and response to treatment
- Provide recommendations for ongoing management
- Determine whether transfer to University of Utah Health is appropriate
- Evaluate whether the patient may benefit from advanced therapies, including VV ECMO
VV ECMO Evaluation
For patients who may be candidates for VV ECMO, University of Utah Health utilizes a multidisciplinary review process involving:
- Pulmonary Critical Care
- Cardiothoracic Surgery
- Cardiovascular Intensive Care specialists
- The team will assess:
- VV ECMO candidacy
- Timing and urgency of transfer
- Whether ECMO support should be initiated prior to transport
- The most appropriate level of care upon arrival
POSSIBLE OUTCOMES
Consultation Only
The University of Utah specialist provides recommendations and the patient remains at the referring facility for continued care.
Transfer for Advanced Respiratory Failure Management
If a higher level of care is needed, the patient may be accepted for transfer to University of Utah Health for advanced pulmonary and critical care management.
Transfer for VV ECMO Evaluation or Support
Patients determined to be potential VV ECMO candidates may be accepted for transfer for ECMO evaluation and/or management.
Alternative Recommendations
If transfer is not indicated, the consulting physician will provide recommendations and discuss alternative options when appropriate.
INFORMATION TO HAVE AVAILABLE
To facilitate consultation, please be prepared to provide:
- Patient demographics
- Current location and level of care
- Referring provider and callback number
- Diagnosis and clinical course
- Current respiratory support settings
- Relevant laboratory and imaging findings
- Insurance information if transfer is being considered
TRANSFER COORDINATION
If transfer is recommended and accepted:
- The Transfer Center will coordinate all transfer logistics.
- Appropriate receiving services will be identified.
- Bed placement and admission processes will be initiated.
- Insurance and financial clearance activities will be performed in parallel and will not delay urgent physician-to-physician communication when clinically necessary.
Contact the University of Utah Transfer Center
For acute respiratory failure consultation, VV ECMO evaluation, or transfer requests, contact the University of Utah Transfer Center 24/7 and request:
Acute Respiratory Failure Consultation
− Examples include:
- Severe hypoxemic or hypercapnic respiratory failure
- Acute-on-chronic respiratory failure
- Questions regarding diagnosis or management
- Assistance determining next steps
Respiratory Failure Transfer Evaluation
− The patient is requiring progressively more support despite standard therapies.
- FiO₂ ≥80%
- P/F ratio <150
- Increasing ventilator requirements
- Prone positioning planned or in progress
- Failure to improve with prone positioning
VV ECMO Consultation or Transfer Evaluation
− Examples include:
- VV ECMO candidacy evaluation
- Advanced ventilator management strategies
- Transfer for advanced respiratory failure management
- Acute-on-chronic respiratory failure requiring specialized evaluation
- Potential lung transplant candidacy when appropriate
- Questions regarding advanced respiratory therapies