Respiratory Distress in the Ventilated ED Patient

• In the ventilated patient with respiratory distress, evaluation of peak and plateau pressures can help to identify the cause.
• Isolated increases in peak pressure suggest increased resistance to airflow and should prompt consideration of the following:
  • kinked or twisted ET tube
  • patient biting ET tube
  • obstructed ET tube
  • bronchospasm
  • lower airway obstruction
• Increases in plateau pressure suggest decreased pulmonary compliance and should prompt consideration of the following:
  • unilateral intubation
  • pneumothorax
  • pulmonary edema
  • worsening pneumonia
  • abdominal HTN/compartment syndrome

References

Santanilla JI, Daniel B, Yeow ME. Mechanical ventilation. Emerg Med Clin N Am 2008;26:849-862.