Use of invasive mechanical ventilation in Australian emergency departments

There are few published reports describing the use of invasive mechanical ventilation in EDs. We explored the characteristics of patients receiving mechanical ventilation, the ventilator modes and parameters used as well as the duration of ventilation and the nature of ventilator decision-making in Australian ED.

We conducted a 2 month prospective survey of adult patients who received invasive mechanical ventilation in 24 Australian ED. Data forms were completed by ED staff during the patient's ED presentation. We documented ventilator settings post intubation, after a 1 h stabilization period, and immediately before ED discharge or extubation. The person responsible for selection of ventilator settings was noted at each time point.

Data were recorded on 307 patients. Altered mental status (179/307 [58%, 95% CI 53-64]) was the most common indication for mechanical ventilation. Volume-controlled modes were most frequently used at all measured time points; with a median tidal volume of 8 mL/kg. Responsibility for initial selection of ventilator settings was shared between ED physicians (157/307 [51%, 95% CI 46-57]), ED nurses (111/307 [36%, 95% CI 31-42]) and ICU or paramedic staff (9/307 [3%, 95% CI 1-5]) (not recorded 30/307 [10%, 95% CI 6-13]). Ongoing responsibility for titration of ventilation was more commonly that of the ED nurse.

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.