• Al Ashry Haitham S HS Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Medical University of South Carolina. alaashry@musc.edu., Jeremy B Richards, Daniel F Fisher, Jeffrey Sankoff, Todd A Seigel, Lauren B Angotti, and Susan R Wilcox.
• Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Medical University of South Carolina. alaashry@musc.edu.
• Respir Care. 2018 Jan 1; 63 (1): 36-42.

BackgroundMechanically ventilated patients increasingly spend hours in emergency department beds before ICU admission. This study evaluated the performance of blood gases in mechanically ventilated subjects in the emergency department and subsequent changes to mechanical ventilation settings.MethodsThis was a multi-center, prospective, observational study of subjects ventilated in the emergency department, conducted at 3 academic emergency departments from July 2011 to March 2013. We measured the rate of arterial blood gas (ABG) and venous blood gas (VBG) analysis, and we assessed the associations between the conditions of hypoxemia, hyperoxia, hypercapnia, or acidemia and changes to mechanical ventilator settings.ResultsOf 292 ventilated subjects, 17.1% did not have a blood gas sent in the emergency department. Ventilator changes were made significantly more frequently for subjects who had an ABG as the initial blood gas sent in the emergency department (odds ratio 2.70, 95% CI 1.46-4.99, P = .002). However, findings of hypoxemia, hyperoxia, hypercapnia, or acidemia were not correlated with ventilator adjustments.ConclusionsIn this prospective observational study of subjects mechanically ventilated in the emergency department, the majority had a blood gas checked while in the emergency department. While ABGs were associated with having changes made to ventilator settings in the emergency department, clinical findings of hypoxemia, hyperoxia, hypercapnia, and acidemia were not. Inattention to blood gas results may lead to missed opportunities in guiding ventilator changes in the emergency department.Copyright © 2018 by Daedalus Enterprises.

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