PT  - JOURNAL ARTICLE
AU  - Robert J Stephens
AU  - Jeffrey E Siegler
AU  - Brian M Fuller
TI  - Mechanical Ventilation in the Prehospital and Emergency Department Environment
AID  - 10.4187/respcare.06888
DP  - 2019 May 01
TA  - Respiratory Care
PG  - 595--603
VI  - 64
IP  - 5
4099  - http://rc.rcjournal.com/content/64/5/595.short
4100  - http://rc.rcjournal.com/content/64/5/595.full
AB  - Patients who require mechanical ventilation in the prehospital and emergency department environments experience high mortality and are at high risk of ventilator-associated ventilator-induced lung injury and ARDS. In addition, little attention has been given in the literature, trainee education, or clinical emphasis to ventilator management in these patients. ARDS and ventilator-induced lung injury are time-sensitive disease processes that develop early in mechanical ventilation and could potentially be prevented with early lung-protective ventilation. Prehospital and emergency department ventilation, in general, is characterized by potentially injurious tidal volume, high FIO2, and low PEEP. Recent literature highlights improved subjects outcomes in the setting of early lung-protective ventilation in both subjects with and those without ARDS. This review of the literature led us to recommend that lung-protective ventilation with avoidance of hyperoxia be the default goal ventilator strategy for all patients with prehospital and emergency department mechanical ventilation. This can be achieved by delivering low tidal volumes with stepwise, concurrent titration of FIO2 and PEEP to facilitate adequate oxygenation.