Lung-protective Ventilation in Emergency Department Patients With Severe Sepsis
Abstract
Lung-protective ventilation (LPV) is a cornerstone of management for patients with established acute respiratory distress syndrome (ARDS) to limit ventilatorinduced lung injury and improve clinical outcomes. While the use of LPV for prevention of ARDS remains controversial, a growing body of evidence supports its use. Fuller and colleagues recently described the limited implementation of LPV for ARDS prevention in emergency department (ED) patients with severe sepsis. While the authors were appropriately cautious in their interpretation of the literature, emergency medicine and critical care physicians must continue to make clinical decisions on ventilator management—what should be recommended? The physiology and biologic plausibility of LPV in patients at risk for ARDS make sense. Numerous studies in multiple animal models have demonstrated that mechanical ventilation with higher tidal volumes damages the previously uninjured lung and causes pulmonary and systemic inflammation. More recently, clinical studies have provided evidence for the use of LPV prior to ARDS development. A recent meta-analysis, including 20 articles with a total of 2,822 participants, demonstrated large beneficial effects for LPV in prevention of acute lung injury and mortality. While the included articles were heterogeneous, effectiveness in diverse patient populations ranging from general intensive care unit patients to post–cardiac surgery patients supports generalizability. Subsequently, yet…
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