There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury.
Our recent issue Ventilator Management of Adult Patients in the Emergency Department reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. An update on managing COVID-19-associated acute respiratory distress syndrome is also included.
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Here are a few key points:
- Initiating best-practice ventilation management in the ED has been shown to decrease duration of ventilation, hospital stay, and mortality.
- Failure to optimize oxygenation and perfusion prior to intubation and mechanical ventilation has been associated with an increased risk of peri-intubation cardiac arrest.
- Hyperoxia in acutely ill patients is harmful. Large reviews have demonstrated an increase in mortality with a liberal oxygenation strategy compared to a more conservative approach.
- Start the newly mechanically ventilated patient at 100% FiO2, but then rapidly titrate down the oxygen until the oxygen saturation is 93%-96%.
Last Updated on December 13, 2021