UMEM Educational Pearls

Mechanical Ventilation in the ED

  • Emergency physicians (EPs) intubate patients on a daily basis.  Due to prolonged lengths of stay for many of these patients, the EP must manage the ventilator during the crucial early hours of critical illness.
  • Despite the marked increase in critically ill patients, emergency medicine residents receive very little training in mechanical ventilation (MV).1
  • In addition, recent literature has demonstrated some common themes regarding MV in the ED.2,3
    • Use of higher than recommended tidal volumes
    • Infrequent use of lung protective ventilation strategies
    • Infrequent monitoring of plateau pressures
  • Take Home Points
    • Pay attention to tidal volume
    • Monitor and maintain plateau pressures < 30 cm H2O


  1. Wilcox SR, et al. Emergency medicine residents' knowledge of mechanical ventilation. J Emerg Med 2015;48:481-91.
  2. Allison MG, Scott MG, Hu K, et al. High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome. J Crit Care 2015;30:341-3.
  3. Fuller BM, et al. Mechanical ventilation and acute respiratory distress syndrome in the emergency department: a multicenter, observational, prospective, cross-sectional study. Chest 2015. [Epub ahead of print]