Susan R Wilcox1, Jeremy B Richards2, Daniel F Fisher3, Jeffrey Sankoff4, Todd A Seigel5. 1. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: susanrwilcoxmd@gmail.com. 2. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: jeremyrichardsmd@gmail.com. 3. Respiratory Care Services, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dfisher2@mgh.harvard.edu. 4. Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO, USA. Electronic address: Jeffrey.sankoff@dhha.org. 5. Department of Emergency Medicine and Critical Care, Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, CA, USA. Electronic address: todd.a.seigel@gmail.com.
Abstract
OBJECTIVE: Mechanical ventilation with low tidal volumes has been shown to improve outcomes for patients both with and without acute respiratory distress syndrome. This study aims to characterize mechanically ventilated patients in the emergency department (ED), describe the initial ED ventilator settings, and assess for associations between lung protective ventilation strategies in the ED and outcomes. METHODS: This was a multicenter, prospective, observational study of mechanical ventilation at 3 academic EDs. We defined lung protective ventilation as a tidal volume of less than or equal to 8 mL/kg of predicted body weight and compared outcomes for patients ventilated with lung protective vs non-lung protective ventilation, including inhospital mortality, ventilator days, intensive care unit length of stay, and hospital length of stay. RESULTS: Data from 433 patients were analyzed. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Two hundred sixty-one patients (60.3%) received lung protective ventilation, but most patients were ventilated with a low positive end-expiratory pressure, high fraction of inspired oxygen strategy. Patients were ventilated in the ED for a mean of 5 hours and 7 minutes but had few ventilator adjustments. Outcomes were not significantly different between patients receiving lung protective vs non-lung protective ventilation. CONCLUSIONS: Nearly 40% of ED patients were ventilated with non-lung protective ventilation as well as with low positive end-expiratory pressure and high fraction of inspired oxygen. Despite a mean ED ventilation time of more than 5 hours, few patients had adjustments made to their ventilators.
OBJECTIVE: Mechanical ventilation with low tidal volumes has been shown to improve outcomes for patients both with and without acute respiratory distress syndrome. This study aims to characterize mechanically ventilated patients in the emergency department (ED), describe the initial ED ventilator settings, and assess for associations between lung protective ventilation strategies in the ED and outcomes. METHODS: This was a multicenter, prospective, observational study of mechanical ventilation at 3 academic EDs. We defined lung protective ventilation as a tidal volume of less than or equal to 8 mL/kg of predicted body weight and compared outcomes for patients ventilated with lung protective vs non-lung protective ventilation, including inhospital mortality, ventilator days, intensive care unit length of stay, and hospital length of stay. RESULTS: Data from 433 patients were analyzed. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Two hundred sixty-one patients (60.3%) received lung protective ventilation, but most patients were ventilated with a low positive end-expiratory pressure, high fraction of inspired oxygen strategy. Patients were ventilated in the ED for a mean of 5 hours and 7 minutes but had few ventilator adjustments. Outcomes were not significantly different between patients receiving lung protective vs non-lung protective ventilation. CONCLUSIONS: Nearly 40% of ED patients were ventilated with non-lung protective ventilation as well as with low positive end-expiratory pressure and high fraction of inspired oxygen. Despite a mean ED ventilation time of more than 5 hours, few patients had adjustments made to their ventilators.
Authors: Tina Nguyen; Kanisha Pope; Paul Capobianco; Mimi Cao-Pham; Soha Hassan; Matthew J Kole; Claire O'Connell; Aaron Wessell; Jonathan Strong; Quincy K Tran Journal: J Emerg Trauma Shock Date: 2020-06-10
Authors: Lauren B Angotti; Jeremy B Richards; Daniel F Fisher; Jeffrey D Sankoff; Todd A Seigel; Haitham S Al Ashry; Susan R Wilcox Journal: West J Emerg Med Date: 2017-07-11
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