Evidence-Based Prehospital Lung Protective Ventilation Protocol Reduces Lung Injury

Protective mechanical ventilation strategies in the prehospital setting Montgomery County Hospital District EMS developed an evidence-based paramedic-initiated lung protective ventilation bundle to reduce ventilator-induced lung injury. Photo courtesy Montgomery County Hospital District Lowering tidal volumes in an effort to reduce lung injury following initiation of mechanical ventilation is far from a new idea, the original ARDSNet data are nearly 20 years old. Recent ED-based studies have shown decreased mortality when lower tidal volumes are used early in ventilated patient management.1 Montgomery County Hospital District (MCHD), which provides EMS services to Montgomery County, just outside the city of Houston, recently implemented protocol changes to allow paramedics to begin lung protective ventilatory steps in an effort to decrease ventilator-induced lung injury (VILI). Mechanical ventilation, although often lifesaving, comes with side effects like any other medical procedure or treatment. When paramedics intubate and place patients on the ventilator, efforts to prevent lung injury must be considered. There are four ways that invasive positive pressure can harm the lungs: 1. Barotrauma: High pressures can damage the alveolar basement membrane. This can occur at much lower pressures than the classically taught barotrauma-related pneumothorax. 2. Volutrauma: Large volumes of gas also over-distend the alveoli and cause structural damage leading to secondary pro-infla...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Patient Care Source Type: news