Initial mechanical ventilator settings and lung protective ventilation in the ED
Autor: | Jeremy B. Richards, Todd A. Seigel, Susan R. Wilcox, Daniel F Fisher, Jeffrey Sankoff |
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Rok vydání: | 2016 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment law.invention 03 medical and health sciences 0302 clinical medicine law Fraction of inspired oxygen medicine Tidal Volume Intubation Humans 030212 general & internal medicine Prospective Studies Intensive care medicine Tidal volume Mechanical ventilation Respiratory Distress Syndrome Ventilators Mechanical Equipment Safety business.industry 030208 emergency & critical care medicine General Medicine Emergency department Equipment Design Middle Aged Intensive care unit Respiration Artificial Intensive Care Units Respiratory failure Anesthesia Emergency Medicine Breathing Female business Respiratory Insufficiency Follow-Up Studies |
Zdroj: | The American journal of emergency medicine. 34(8) |
ISSN: | 1532-8171 |
Popis: | 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. |
Databáze: | OpenAIRE |
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