Tuesday, March 14, 2017

Lung Protective Ventilation

R.E.B.E.L.EM - March 13, 2017
"Background: Intubation and mechanical ventilation are commonly performed ED interventions and although patients optimally go to an ICU level of care afterwards, many of them remain in the ED for prolonged periods of time. It is widely accepted that the utilization of lung protective ventilation reduces ventilator-associated complications, including acute respiratory distress syndrome (ARDS). Additionally, it is believed that ventilatory-associated lung injury can occur early after the initiation of mechanical ventilation thus making ED management vital in preventing this disorder. Despite this, intubated ED patients are not optimally ventilated used lung-protective strategy on a routine basis.
Clinical Question: Can the adoption of an ED lung-protective ventilation protocol decrease the frequency of ventilator associated complications?...
Clinical Bottom Line:
Patients intubated in the ED without reactive airway disease should be ventilated with a lung protect approach. Starting lung protective ventilation in the ED is feasible, it influences ventilator settings in the ICU and reduces pulmonary complications. Implementation includes getting an accurate height to use for the tidal volume, minimal FiO2 to meet an O2 saturation greater than 90%, matching PEEP to the FiO2 according to the ARDSNet protocol, keeping the plateau pressure < 30 mm Hg and keeping the head of the bed at 30 degrees.