Invasive mechanical ventilation in the emergency department

Abstract

Emergency department (ED) lenght of stay of the patients requiring admission to the intensive care units has increased gradually in recent years. Mechanical ventilation is an integral part of critical care and mechanically ventilated patients have to be managed and monitored by emergency physicians for longer than expected in EDs. This early period of care has significant impact on the outcomes of these patients. Therefore, emergency physicians should have comprehensive knowledge of mechanical ventilation. This review will summarize the current literature of the basic concepts, appropriate clinical applications, monitoring parameters, components and mechanisms of mechanical ventilation in the ED.

ResUHUrge: A Low Cost and Fully Functional Ventilator Indicated for Application in COVID-19 Patients

“…The inspiratory trigger is defined as the condition that allows determining the beginning of inspiration and the end of expiration, and therefore defines the expiration time (Exp Time ) and the imposition of the IPAP pressure setpoint [16,30]. On the other hand, the cycling condition determines the end of inspiration and the beginning of expiration, that is, it defines the inspiration time (Insp Time ) and the imposition of the EPAP pressure setpoint [16,30]. Both conditions can be given by airflow (assisted mode) or by time (controlled mode).…”

“…) and the imposition of the IPAP pressure setpoint [16,30]. On the other hand, the cycling condition determines the end of inspiration and the beginning of expiration, that is, it defines the inspiration time (Ins ) and the imposition of the EPAP pressure setpoint [16,30]. Both conditions can be given by airflow (assisted mode) or by time (controlled mode).…”

“…The trigger level can be selected according to the patient's respiratory conditions so that the selected value maintains a compromise between vulnerability to false triggers and the inspiratory effort required by the patient, which may result in the patient failing to synchronize with the ventilator [16,33].…”

“…In the first instance, we can find models made with 3D designs and electrical motors that generate the airflow through a compression mechanism regulated in time and volume over an airway mask bag unit (AMBU) [13,14] or bag valve mask (BVM) [15,16]. These proposals are characterized by a simple, open-source, low-cost, and high reproducibility ventilator model.…”

Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents

“…Learners had to listen for bilateral breath sounds to assess for pneumothorax, recognize high auto-positive end-expiratory pressure (auto-PEEP), disconnect the ventilator, and adjust the respiratory rate and inspiratory to expiratory ratio to allow adequate time for exhalation. The case was concluded with a debriefing session on the importance of recognition of auto-PEEP and the use of permissive hypercapnia in patients with obstructive lung disease and to recognize the findings of auto-PEEPing on a ventilator [10,11].…”