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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
- Wilcox SR, et al. Emergency medicine residents' knowledge of mechanical ventilation. J Emerg Med 2015;48:481-91.
- 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.
- 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]