When I was a resident, every vent lecture either put me to sleep or left me dazed and bewildered. I gave a lecture of that ilk when I started working after fellowship. I had become part of the problem. I decided there must be a way to make vent management more understandable and if not interesting, at least bearable. Right now, the actual knowledge in most of EM on vents is dismal [PMIDs: 27330658 and 25497896]
This lecture offers a path to managing any patient on the ventilator in the ED. I have tried to simplify as much as possible while still maintaining an evidence-based approach.
This is Part I, it deals with the lung injury strategy. In a future episode, we'll talk about the strategy for patients with obstructive lung disease.
There are only 4 things you need to remember for a lung injury patient:
Vt (Tidal Volume) = Lung Protection
Flow Rate = Patient Comfort
Resp Rate = Ventilation
FiO2/PEEP = Oxygenation
First, read my Ventilator Article in the Annals of EM [Managing-Initial-Vent-ED]
Then, print out this Handout for the Dominating the Vent Series
Additional New Information
- American Journal of Respiratory and Critical Care Medicine Vol. 195, No. 4 | Feb 15, 2017 Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure
- LOV-ED Low Ventilation Trial (Ann Emerg Med 2017;70:406)
- Low Tidal Volume in the ED decreases mortality: Lung-Protective Ventilation and Associated Outcomes and Costs Among Patients Receiving Invasive Mechanical Ventilation in the Emergency Department. Chest. 2020 Sep 20;S0012-3692(20)34522-0. doi: 10.1016/j.chest.2020.09.100.
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