Research and Reviews in the Fastlane 182

This study was called LOV-ED. Initiation of a mechanical ventilation protocol in the ED using a low tidal volume strategy, PEEP protocols, rapid FiO2 weaning, and head-of-bed elevation resulted in dramatic clinical improvement in the composite primary outcome: ARDS or ventilator-associated conditions; NNT = 14. And a secondary outcome, mortality, was also improved, NNT = 7. There is no way to account for all the confounders or other process improvements that may have also led to better outcomes, but the use of propensity analysis makes this association very believable. REBEL EM has a great deep-dive on this article. Starting lung protective ventilation in the ED is feasible, it influences ventilator settings in the ICU and reduces pulmonary complications. Implementation includes getting an accurate height to use for the tidal volume, minimal FiO2 to meet an O2 saturation greater than 90%, matching PEEP to the FiO2 according to the ARDSNet protocol, keeping the plateau pressure < 30 mm Hg and keeping the head of the bed at 30 degrees. Lung protective strategy has been around for more than a decade but continues to not be widely embraced particularly in the ED. This before and after study demonstrates that implementing a lung-protective strategy isn’t just feasible but is associated with decreased ARDS, increased ventilator and ICU free days and decreased mortality. Patients intubated in the ED without reactive airway disease should be ventilated with a lung protect ap...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs