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Mechanical ventilation of adults in the emergency department

Peter Hou, MD
Amado Alejandro Baez, MD, MSc, MPH, FAAEM, FCCM
Section Editor
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Patients present to the emergency department (ED) with a wide range of conditions that may require tracheal intubation or positive pressure ventilation, including: pneumonia, asthma, chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, acute respiratory distress syndrome, stroke, trauma, drug overdose, severe sepsis, shock, and neuromuscular disorders such as myasthenia gravis or Guillain-Barré syndrome.

Once a definitive airway has been secured, ventilatory management ensues. Ventilatory strategies vary according to the clinical scenario, and to provide optimal care, emergency clinicians must understand the fundamental concepts of mechanical ventilation.

This topic review will discuss concepts needed to manage mechanical ventilation in the ED, including ventilator settings, modes of mechanical ventilation, complications of mechanical ventilation, management of ventilated patients in distress, general and disease-specific ventilation strategies, and weaning from ventilatory support [1-5]. Although useful guidelines are provided, clinicians will need to individualize mechanical ventilation strategies based upon the clinical scenario. Tracheal intubation and other aspects of airway management are discussed elsewhere. (See "Rapid sequence intubation for adults outside the operating room" and "Rapid sequence intubation (RSI) outside the operating room in children: Approach".)


Clinicians place patients on mechanical ventilation to accomplish any of a number of goals, including:

To protect the airway

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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