• Brian M Fuller, Nicholas M Mohr, Christopher N Miller, Andrew R Deitchman, Brian J Levine, Nicole Castagno, Elizabeth C Hassebroek, Adam Dhedhi, Nicholas Scott-Wittenborn, Edward Grace, Courtney Lehew, and Marin H Kollef.
• Department of Emergency Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, MO; Department of Anesthesiology, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, MO. Electronic address: fullerb@wusm.wustl.edu.
• Chest. 2015 Aug 1; 148 (2): 365374365-374.

BackgroundThere are few data regarding mechanical ventilation and ARDS in the ED. This could be a vital arena for prevention and treatment.MethodsThis study was a multicenter, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS after admission. Multivariable logistic regression was used to determine the predictors of ARDS.ResultsWe analyzed 219 patients receiving mechanical ventilation to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight (PBW) (interquartile range, 6.9-8.9), with a range of 4.3 to 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 patients (55.7%). The incidence of ARDS after admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the 15 patients with ARDS in the ED (6.8%), lung-protective ventilation was used in seven (46.7%). Patients who progressed to ARDS experienced greater duration in organ failure and ICU length of stay and higher mortality.ConclusionsLung-protective ventilation is infrequent in patients receiving mechanical ventilation in the ED, regardless of ARDS status. Progression to ARDS is common after admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset after admission from the ED, measures to prevent onset and to mitigate severity should be instituted in the ED.Trial RegistryClinicalTrials.gov; No.: NCT01628523; URL: www.clinicaltrials.gov.

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