Use of invasive mechanical ventilation in Australian emergency departments

Rose, Louise; Gerdtz, Marie

doi:10.1111/j.1742-6723.2009.01167.x

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…Even when inadequate mechanical ventilation practices are used for only brief periods, hospital stays are often prolonged, and patients can experience mechanical ventilation-induced injuries 8 - 10 . These consequences are becoming increasingly common across various hospital departments 11 , 12 . Exacerbating the situation, many physicians with no formal training in mechanical ventilation end up managing critically ill patients undergoing this intervention 13 - 16 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

Tallo

Abib

Negri

et al. 2017

Clinics

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OBJECTIVE:To present self-assessments of knowledge about mechanical ventilation made by final-year medical students, residents, and physicians taking qualifying courses at the Brazilian Society of Internal Medicine who work in urgent and emergency settings.METHODS:A 34-item questionnaire comprising different areas of knowledge and training in mechanical ventilation was given to 806 medical students, residents, and participants in qualifying courses at 11 medical schools in Brazil. The questionnaire’s self-assessment items for knowledge were transformed into scores.RESULTS:The average score among all participants was 21% (0-100%). Of the total, 85% respondents felt they did not receive sufficient information about mechanical ventilation during medical training. Additionally, 77% of the group reported that they would not know when to start noninvasive ventilation in a patient, and 81%, 81%, and 89% would not know how to start volume control, pressure control and pressure support ventilation modes, respectively. Furthermore, 86.4% and 94% of the participants believed they would not identify the basic principles of mechanical ventilation in patients with obstructive pulmonary disease and acute respiratory distress syndrome, respectively, and would feel insecure beginning ventilation. Finally, 77% said they would fear for the safety of a patient requiring invasive mechanical ventilation under their care.CONCLUSION:Self-assessment of knowledge and self-perception of safety for managing mechanical ventilation were deficient among residents, students and emergency physicians from a sample in Brazil.

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Section: Introductionmentioning

confidence: 99%

Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

Tallo

Abib

Negri

et al. 2017

Clinics

View full text Add to dashboard Cite

show abstract

“…In the final analysis, 21 studies were included. Eleven studies provided outcome data and were meta-analyzed (6, 11, 28, 35–42); 10 studies provided descriptive tidal volume data (16–18, 43–49). Supplemental Digital Content 5 (http://links.lww.com/CCM/H45) displays the study flow diagram at each stage of the review.…”

Section: Resultsmentioning

confidence: 99%

Low Tidal Volume Ventilation for Emergency Department Patients: A Systematic Review and Meta-Analysis on Practice Patterns and Clinical Impact*

Monnin

Terian

Yaegar

et al. 2022

Critical Care Medicine

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Data suggest that low tidal volume ventilation (LTVV) initiated in the emergency department (ED) has a positive impact on outcome. This systematic review and meta-analysis quantify the impact of ED-based LTVV on outcomes and ventilator settings in the ED and ICU. DATA SOURCES:We systematically reviewed MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, references, conferences, and ClinicalTrials.gov. STUDY SELECTION:Randomized and nonrandomized studies of mechanically ventilated ED adults were eligible.DATA EXTRACTION: Two reviewers independently screened abstracts. The primary outcome was mortality. Secondary outcomes included ventilation duration, lengths of stay, and occurrence rate of acute respiratory distress syndrome (ARDS). We assessed impact of ED LTVV interventions on ED and ICU tidal volumes. DATA SYNTHESIS:The search identified 1,023 studies. Eleven studies (n = 12,912) provided outcome data and were meta-analyzed; 10 additional studies (n = 1,863) provided descriptive ED tidal volume data. Overall quality of evidence was low. Random effect meta-analytic models revealed that ED LTVV was associated with lower mortality (26.5%) versus non-LTVV (31.1%) (odds ratio, 0.80 [0.72-0.88]). ED LTVV was associated with shorter ICU (mean difference, −1.0; 95% CI, −1.7 to −0.3) and hospital (mean difference, −1.2; 95% CI, −2.3 to −0.1) lengths of stay, more ventilator-free days (mean difference, 1.4; 95% CI, 0.4-2.4), and lower occurrence rate (4.5% vs 8.3%) of ARDS (odds ratio, 0.57 [0.44-0.75]). ED LTVV interventions were associated with reductions in ED (−1.5-mL/kg predicted body weight [PBW] [−1.9 to −1.0]; p < 0.001) and ICU (−1.0-mL/kg PBW [−1.8 to −0.2]; p = 0.01) tidal volume. CONCLUSIONS:The use of LTVV in the ED is associated with improved clinical outcomes and increased use of lung protection, recognizing low quality of evidence in this domain. Interventions aimed at implementing and sustaining LTVV in the ED should be explored.

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“…A recent study found that ICU crowding, with ICUs functioning at greater than 20% above the average annual census, was associated with an increased ED LOS. 29 With these dual factors of increasing acuity with worsening crowding, the incidence of mechanically ventilated patients in the ED is growing 37 and their LOS in the ED is increasing. 22 EPs, therefore, may be primarily responsible for prolonged management of mechanically ventilated patients.…”

Section: Discussionmentioning

confidence: 99%

Duration of Mechanical Ventilation in the Emergency Department

Angotti¹,

Richards²,

Fisher³

et al. 2017

WestJEM

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IntroductionDue to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).MethodsThis was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. All consecutive adult patients on invasive mechanical ventilation were eligible for enrollment. We performed a Cox regression to assess for a mortality effect for mechanically ventilated patients with each hour of increasing LOS in the ED and multivariable regression analyses to assess for independently significant contributors to in-hospital mortality. Our primary outcome was in-hospital mortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. We further commented on use of lung protective ventilation and frequency of ventilator changes made in this cohort.ResultsWe enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time of mechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer total duration of intubation. However, adjusted multivariable regression analysis demonstrated only older age and admission to the neurosciences ICU as independently associated with increased mortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours had changes made to their ventilator.ConclusionIn a prospective observational study of patients mechanically ventilated in the ED, there was a significant mortality benefit to expedited transfer of patients into an appropriate ICU setting.

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Use of invasive mechanical ventilation in Australian emergency departments

Abstract: The application of mechanical ventilation was similar to descriptions reported in the critical care literature both in Australia and internationally. Decision-making responsibilities were shared by ED medical and nursing staff.

Cited by 11 publications

References 26 publications

Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

Low Tidal Volume Ventilation for Emergency Department Patients: A Systematic Review and Meta-Analysis on Practice Patterns and Clinical Impact*

Duration of Mechanical Ventilation in the Emergency Department

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