Mechanical Ventilation in the ED

• Emergency physicians (EPs) intubate patients on a daily basis.  Due to prolonged lengths of stay for many of these patients, the EP must manage the ventilator during the crucial early hours of critical illness.
• Despite the marked increase in critically ill patients, emergency medicine residents receive very little training in mechanical ventilation (MV).¹
• In addition, recent literature has demonstrated some common themes regarding MV in the ED.^2,3
  • Use of higher than recommended tidal volumes
  • Infrequent use of lung protective ventilation strategies
  • Infrequent monitoring of plateau pressures
• Take Home Points
  • Pay attention to tidal volume
  • Monitor and maintain plateau pressures < 30 cm H2O

References

1. Wilcox SR, et al. Emergency medicine residents' knowledge of mechanical ventilation. J Emerg Med 2015;48:481-91.
2. Allison MG, Scott MG, Hu K, et al. High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome. J Crit Care 2015;30:341-3.
3. Fuller BM, et al. Mechanical ventilation and acute respiratory distress syndrome in the emergency department: a multicenter, observational, prospective, cross-sectional study. Chest 2015. [Epub ahead of print]