Originally approved October 2017
Airway management is a cornerstone of emergency medicine practice and one of the expert skills of the emergency physician. The emergency physician should not only be adept at endotracheal intubation but also familiar with the strategies involved in the initial management of mechanical ventilation. Choosing an appropriate ventilator strategy will ensure the best clinical outcome and avoid complications, such as barotrauma, oxygen toxicity, and ventilator-associated pneumonia. This is particularly relevant in the setting of crowding, prolonged emergency department (ED) boarding times, and rise in the number of ED-based critical care units. A collaborative team effort that includes nursing and respiratory care is essential to providing optimal care of the ventilated patient.
The American College of Emergency Physicians (ACEP) is the authoritative body for the establishment of guidelines for rapid sequence intubation and mechanical ventilation in the emergency setting. To promote the safe and effective use of mechanical ventilation in ED patients, ACEP recommends the following:
Brower RG, Matthay MA, Morris A, et al. For the Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301-1308.
Spiegel R, Mallemat H. Emergency department treatment of the mechanically ventilated patient. Emerg Med Clin N Am. 2016;341:63-75.
Weingart SD. Managing initial mechanical ventilation in the emergency department. Ann Emerg Med. 2016;68:614-617.