Does Low Tidal Volume Matter in the Emergency Department?

Written by Clay Smith

Spoon Feed
Starting low tidal volume ventilation in the ED is associated with lower mortality and overall better outcomes.

Why does this matter?
We know ARDS-Net lung-protective ventilation (LPV) strategies work to improve patient outcomes. Does it matter if we start right away after intubating in the ED?

What you do matters – even vent settings.
This was a retrospective study of 8 EDs, 4,174 patients total, with 2,437 who received LPV (≤8mL/kg tidal volume). For the primary outcome of in-hospital mortality, those who received LPV had an aOR of 0.91 (95%CI 0.84-0.96). That’s a 9% lower odds of death. There were also several other important secondary outcomes: lower ventilator days, hospital days, and cost. This study included all-comers intubated in the ED and transferred to the ICU in these 8 Canadian EDs. Not all these patients had acute lung injury as the reason for intubation, yet they still did better with low tidal volume. Vent settings matter in the ED. Work with RT and aim for ≤8mL/kg. You may want to review this post – Manage the Vent Like a Pro – or download this Mechanical Ventilation Made Simple cheatsheet.

Source
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. Online ahead of print.

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