Conclusions and Key Concepts

Abstract

Many terms are used interchangeably in mechanical ventilation, and this leads to confusion. Select appropriate terms, and use them consistently. Key concepts include tidal volume, respiratory rate, minute ventilation, PEEP, resistance, compliance, peak inspiratory pressure, plateau pressure, autoPEEP, and derecruitment. Modes of ventilation are assist control (including volume control and pressure control, as well as pressure-regulated volume control), pressure support, and synchronized intermittent mandatory ventilation. Tidal volume should be selected for 6–8 mL/kg of predicted body weight, based upon height and sex. The respiratory rate should be selected to target a reasonable minute ventilation. PEEP should be set at minimum of 5 cmH₂O, and titrated higher as needed to correct for hypoxemia and derecruitment. Once the ventilator settings are selected the patient must be continuously reassessed, settings such be titrated based on ABG results, and peak inspiratory pressures and plateau pressures monitored to reduce harm. Patients with acute respiratory distress syndrome (ARDS), asthma, COPD, and neurologic injury are especially vulnerable populations of ventilated patients who require additional attention and careful ventilator management. While mechanically ventilated patients are among the most critically ill patients cared for in the ED, appropriate, evidence-based care can positively impact the patients’ trajectories and improve outcomes.