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 was up on the soon to be defunct EMCrit Lecture site. It 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. Next week, 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

Read More

First, read my Ventilator Article [Managing-Initial-Vent-ED]

Then, print out this Handout

Audio Only

If you need just the audio [right or cntrl click here]

Updated Refs

* 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.

 

Now on to the Vodcast...