Episode 30 - Lung Protective Ventilation With Dr. Nick Mohr

Lowering tidal volumes in effort to reduce lung injury following initiation of mechanical ventilation is far from a new idea, the original ARDS-NET data are nearly 20 years old. Lung protective ventilatory strategies have progressively been shown, from the ICU and now into the ED setting, to decrease ventilator days, ICU/hospital stay and overall mortality. This discussion covers the original ARDS-NET study, causes of ventilator induced lung injury, and closes with MCHD’s efforts to initiate lung protective settings in ventilated patients in the prehospital setting. References: 1. Fuller BM, Ferguson I, Mohr NM, et al. Lung-protective ventilation initiated in the emergency department (LOV-ED): a study protocol for a quasi-experimental, before-after trial aimed at reducing pulmonary complications BMJ Open 2016;6:e010991. 2. Boyer AF, Schoenberg N, Babcock H, et al. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 2015;147:68–81. 3. Ranieri VM, Rubenfeld GD, Thompson BT, et al. The ARDS definition task force. Acute respiratory distress syndrome. JAMA 2012;307:2526–2533. 4. (No authors listed). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301–1308. 5. Austin Michael A, Wills Karen E, Blizzard Leigh, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial BMJ 2010; 341 6. Turner JS, et al. Feasibility of upright patient positioning and intubation success rates at two academic emergency departments, American Journal of Emergency Medicine 2017. 7. Stoltze AJ, Wong TS, Harland KK, et al. Prehospital tidal volume influences hospital tidal volume: A cohort study. J Crit Care. 2015 Jun;30(3):495–501.