title: Prehospital tidal volume influences hospital tidal volume: A cohort study.
abstract: OBJECTIVE
  The purposes of the study are to describe current practice of ventilation in a modern air medical system and to measure the association of ventilation strategy with subsequent ventilator care and acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  Retrospective observational cohort study of intubated adult patients (n = 235) transported by a university-affiliated air medical transport service to a 711-bed tertiary academic center between July 2011 and May 2013. Low tidal volume ventilation was defined as tidal volumes less than or equal to 8 mL/kg predicted body weight. Multivariable regression was used to measure the association between prehospital tidal volume, hospital ventilation strategy, and ARDS.
  
  
  RESULTS
  Most patients (57%) were ventilated solely with bag valve ventilation during transport. Mean tidal volume of mechanically ventilated patients was 8.6 mL/kg predicted body weight (SD, 0.2 mL/kg). Low tidal volume ventilation was used in 13% of patients. Patients receiving low tidal volume ventilation during air medical transport were more likely to receive low tidal volume ventilation in the emergency department (P < .001) and intensive care unit (P = .015). Acute respiratory distress syndrome was not associated with prehospital tidal volume (P = .840).
  
  
  CONCLUSIONS
  Low tidal volume ventilation was rare during air medical transport. Air transport ventilation strategy influenced subsequent ventilation but was not associated with ARDS.
authors: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242.
authors: Andrew J
authors: AJ
authors: Stoltze
authors: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242.
authors: Terrence S
authors: TS
authors: Wong
authors: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242.
authors: Karisa K
authors: KK
authors: Harland
authors: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242.
authors: Azeemuddin
authors: A
authors: Ahmed
authors: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63110; Division of Critical Care, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
authors: Brian M
authors: BM
authors: Fuller
authors: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242. Electronic address: nicholas-mohr@uiowa.edu.
authors: Nicholas M
authors: NM
authors: Mohr
mesh_terms: D000328:Adult; D000368:Aged; D017732:Air Ambulances; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control
keywords: Adult respiratory distress syndrome; Artificial respiration; Emergency care; Intubation; Prehospital; Prevention and control