Background: Emergency medicine (EM) physicians are experts in airway and intubation, however less emphasis exists on the importance of post intubation management of mechanical ventilation (MV). Low tidal volume ventilation (LTVV), defined as £8ml/kg of ideal body weight (IBW) is considered lung-protective ventilation (LPV). LPV is shown to decrease ventilator associated complications (VACs). Little is known of what determines who receives LTVV in the emergency department (ED). The objective of this study was to determine if patients receive LTVV in the ED, and if so, what role gender and body mass index (BMI) may have on LPV.
Methods: A retrospective chart review of adult patients intubated in a tertiary care, academic ED from 12/31/13 - 12/31/16 was conducted. Patients were included if they were intubated in the ED and admitted to either a medical or surgical intensive care unit. Initial post-intubation ED ventilator settings and reason for intubation was collected, as was demographic data including gender, age, height, BMI, and IBW. Outcome data was also collected including development of VACs, days on MV, need for tracheostomy, and mortality.
Results: Analysis included 455 patients, 248 men and 207 women (p = 0.75). The majority of patients did not receive LTVV of£8ml/kg of IBW (n = 265; 58.2%). When compared to men, women were less likely to receive LTVV (adjusted odds ratio 0.15; 95% confidence interval [CI] 0.09 to 0.23; p < 0.001). Obese women, classified as a BMI ³30, were least likely to receive LTVV, compared to non-obese men and women (p < 0.001). Obese women were also more likely to receive significantly larger tidal volumes of ³10cc/kg of IBW compared to obese men (adjusted odds ratio 7.50; 95% confidence interval [CI] 2.01 to 48.89; p = 0.01). There were no differences in those who received LTVV based on age. There were no differences observed in outcome measures.
Conclusions: The prevalence of LTVV practices in the ED is low. Ventilation gender disparities exist. Women compared to men, particularly obese women, may be disproportionately at risk for development of ventilator associated complications.