Prehospital Vent Management Matters

Prehospital vent management matters
Compliance with ARDSnet ventilator strategies (low tidal volume, especially PEEP/FiO2 ratios) in combat patients transferred by air from Afghanistan to Germany was associated with decreased mortality (2% vs. 7%) and shorter ICU stay.  The data was retrospective, and patients non-compliant with ARDSnet ventilation had higher injury severity scores.  So the association of lower mortality with low tidal volumes could be confounded.  Regardless, we know low tidal volume ventilation is a best practice and decreases mortality in other settings.  It makes sense to start it in the prehospital arena.  For more on vent management, see Manage the Vent Like a Pro.

Spoon Feed
Prehospital ARDSnet ventilation strategies appear to reduce mortality, ICU length of stay, and days on the ventilator.

Source
Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality.  J Trauma Acute Care Surg. 2017 May 30. doi: 10.1097/TA.0000000000001607. [Epub ahead of print]

Peer reviewed by Thomas Davis.

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