title: Initial mechanical ventilator settings and lung protective ventilation in the ED.
abstract: OBJECTIVE
  Mechanical ventilation with low tidal volumes has been shown to improve outcomes for patients both with and without acute respiratory distress syndrome. This study aims to characterize mechanically ventilated patients in the emergency department (ED), describe the initial ED ventilator settings, and assess for associations between lung protective ventilation strategies in the ED and outcomes.
  
  
  METHODS
  This was a multicenter, prospective, observational study of mechanical ventilation at 3 academic EDs. We defined lung protective ventilation as a tidal volume of less than or equal to 8 mL/kg of predicted body weight and compared outcomes for patients ventilated with lung protective vs non-lung protective ventilation, including inhospital mortality, ventilator days, intensive care unit length of stay, and hospital length of stay.
  
  
  RESULTS
  Data from 433 patients were analyzed. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Two hundred sixty-one patients (60.3%) received lung protective ventilation, but most patients were ventilated with a low positive end-expiratory pressure, high fraction of inspired oxygen strategy. Patients were ventilated in the ED for a mean of 5 hours and 7 minutes but had few ventilator adjustments. Outcomes were not significantly different between patients receiving lung protective vs non-lung protective ventilation.
  
  
  CONCLUSIONS
  Nearly 40% of ED patients were ventilated with non-lung protective ventilation as well as with low positive end-expiratory pressure and high fraction of inspired oxygen. Despite a mean ED ventilation time of more than 5 hours, few patients had adjustments made to their ventilators.
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: susanrwilcoxmd@gmail.com.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: jeremyrichardsmd@gmail.com.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Richards
authors.affiliation: Respiratory Care Services, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dfisher2@mgh.harvard.edu.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Fisher
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO, USA. Electronic address: Jeffrey.sankoff@dhha.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sankoff
authors.affiliation: Department of Emergency Medicine and Critical Care, Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, CA, USA. Electronic address: todd.a.seigel@gmail.com.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Seigel
mesh_terms: D004867:Equipment Design; D004869:Equipment Safety / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000592:standards*; D012128:Respiratory Distress Syndrome / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000628:therapy*; D013990:Tidal Volume; D012122:Ventilators, Mechanical / Q000592:standards*