Pearls & Pitfalls of Emergency Department Mechanical Ventilation

Conference 11/22/2017
by Ani Aydin, MD
Assistant Professor,
Department of Emergency Medicine, Yale University School of Medicine, Yale-New Haven Hospital

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Quick Tips:

• Do not use the same vent settings for every patient you intubate!!
• You can cause worsening of the condition in the first hour if you set the ventilator and walk away.
• Indications for Mechanical Ventilation:
  • Hypercapnic Respiratory Failure (high PaCO2- person not ventilating)
    • To fix the issue, change Tidal Volume or Respiratory Rate
  • Hypoxic Respiratory Failure
    • To fix the issue, change FiO2 or PEEP
• Positive Pressure Ventilation
  • Decreased venous return –> decreases preload
    • If dehydrated prior, will decrease BP
  • Increase transmural pressure –> Decrease afterload
  • Too much pressure on chest –> pressure on capillaries –> can decrease gas exchange
• Peak Airway Pressure- should be less than 35
  • Higher peak airway pressure- think of obstruction
• Plateau Pressure- should be less than 30
  • Higher plateau pressure- lung related
• Peak airway pressures high but normal plateau pressures
  • Think about problem being from the neck up (biting down on tube, kink in ETT, bronchospasm, mucus plug, etc)