Mechanical ventilation of adults in the emergency department
- Peter Hou, MD
Peter Hou, MD
- Instructor in Medicine
- Harvard Medical School
- Amado Alejandro Baez, MD, MSc, MPH, FAAEM, FCCM
Amado Alejandro Baez, MD, MSc, MPH, FAAEM, FCCM
- Residency Director
- Jackson Memorial Hospital
- University of Miami Miller School of Medicine
- Section Editor
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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".)
OBJECTIVES AND OVERVIEW OF MECHANICAL VENTILATION
Clinicians place patients on mechanical ventilation to accomplish any of a number of goals, including:
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- OBJECTIVES AND OVERVIEW OF MECHANICAL VENTILATION
- VENTILATOR SETTINGS
- MODES OF VENTILATION
- APPROACH TO VENTILATORY MANAGEMENT
- General principles
- Selecting a ventilatory strategy
- Implementing the chosen ventilatory strategy
- - Noninvasive positive pressure ventilation
- - General invasive positive pressure ventilation
- - Lung-protective positive pressure ventilation
- DISEASE-SPECIFIC VENTILATORY MANAGEMENT
- Pulmonary diseases
- - Asthma and COPD
- - Hypoxemic respiratory failure
- - Acute cardiogenic pulmonary edema
- - Acute respiratory distress syndrome
- Neuromuscular diseases
- - Guillain-Barré syndrome
- - Myasthenia gravis
- Elevated intracranial pressure
- Other conditions
- - Pregnancy
- - Abdominal compartment syndrome
- APPROACH TO VENTILATED PATIENT IN DISTRESS
- SEDATION AND ANALGESIA FOR THE VENTILATED PATIENT
- WEANING AND DISCONTINUATION OF MECHANICAL VENTILATION
- SUMMARY AND RECOMMENDATIONS