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