title: High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome.
abstract: OBJECTIVE
  Emergency department (ED) patients are at high risk for the acute respiratory distress syndrome (ARDS). Settings only 1 mL/kg above recommended tidal volumes confers harm for these patients. The purpose of this study was to determine whether ED physicians routinely initiate mechanical ventilation with low tidal volumes in patients at risk for ARDS.
  
  
  METHODS
  We retrospectively reviewed the charts of all adult patients who were intubated in an urban, academic ED. The charts were analyzed to identify patients in whom ARDS developed within 48 hours after ED admission. Patients were eligible for inclusion if they had bilateral infiltrates on imaging, had a Pao2/Fio2 ratio less than 300 mm Hg and did not have heart failure contributing to their presentation. The tidal volumes set in the ED were then compared with the recommended tidal volume of 6 mL/kg of predicted body weight.
  
  
  RESULTS
  The initial tidal volumes set in the ED were higher than recommended by an average of 80 mL (95% confidence interval, 60-110, P < .0001) or 1.5 mL/kg (95% confidence interval, 1.0-1.9). Only 5 of the 34 patients received the recommended tidal volume ventilation setting.
  
  
  CONCLUSIONS
  In an academic, tertiary hospital, newly intubated ED patients in whom ARDS developed within 48 hours after intubation were ventilated with tidal volumes that exceeded recommendations by an average of 1.5 mL/kg.
authors: Emergency Medicine/Internal Medicine/Critical Care Medicine Residency, University of Maryland Medical Center. Electronic address: mgallison@gmail.com.
authors: Michael G
authors: MG
authors: Allison
authors: Emergency Medicine/Internal Medicine/Critical Care Medicine Residency, University of Maryland Medical Center.
authors: Michael C
authors: MC
authors: Scott
authors: Emergency Medicine/Internal Medicine/Critical Care Medicine Residency, University of Maryland Medical Center.
authors: Kami M
authors: KM
authors: Hu
authors: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors: Michael D
authors: MD
authors: Witting
authors: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors: Michael E
authors: ME
authors: Winters
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012306:Risk; D013990:Tidal Volume
keywords: Acute Lung Injury; Acute Respiratory Distress Syndrome; Emergency Medicine; Mechanical Ventilation; Tidal Volume