Introduction National Service Evaluations of COVID-19 ARDS care showed significant variability in clinical practice and adherence to guidelines. To better understand this, we explored factors influencing decision-making around mechanical ventilation in COVID-19.

Methods We conducted interprofessional focus groups identifying factors that influenced decision making through thematic analysis. We then developed a questionnaire to validate these themes with critical care professionals nationwide. Kruskal-Wallis or Mann-Whitney U tests were used.

Results There were 179 complete responses. 80% of clinicians thought COVID-19 ARDS presented differently to their previous experience of ARDS and 72% thought deviating from usual practice was necessary. Doctors were more likely to think deviation was necessary (p<0.01). Clinicians reported their ventilatory decision-making was most influenced by disease factors, then team, then contextual and least by environmental (p<0.01). 68% reported not being confident in their ventilatory decision-making. Clinicians who felt COVID-19 ARDS presentation fitted with their previous experience of ARDS reported greater confidence (p<0.01) but experience (p=0.52) and profession (p=0.29) had no effect (Figure 1).

Conclusion Clinicians were influenced by the uncertain understanding of COVID-19 ARDS. In the event of another novel disease, developing clinical models of disease should be prioritised to optimise decision making.