Ventilator strategies and rescue therapies for management of acute respiratory failure in the emergency department

Jarrod M. Mosier, Cameron Hypes, Raj Joshi, Sage Whitmore, Sairam Parthasarathy, Charles B. Cairns

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.

Original languageEnglish (US)
Pages (from-to)529-541
Number of pages13
JournalAnnals of Emergency Medicine
Volume66
Issue number5
DOIs
StatePublished - Nov 1 2015

Fingerprint

Mechanical Ventilators
Respiratory Insufficiency
Hospital Emergency Service
Noninvasive Ventilation
Neuromuscular Blockade
Extracorporeal Membrane Oxygenation
Continuous Positive Airway Pressure
Tidal Volume
Adult Respiratory Distress Syndrome
Artificial Respiration
Intubation
Chronic Obstructive Pulmonary Disease
Pneumonia
Nitric Oxide
Therapeutics
Asthma
Heart Failure
Lung
Mortality

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Ventilator strategies and rescue therapies for management of acute respiratory failure in the emergency department. / Mosier, Jarrod M.; Hypes, Cameron; Joshi, Raj; Whitmore, Sage; Parthasarathy, Sairam; Cairns, Charles B.

In: Annals of Emergency Medicine, Vol. 66, No. 5, 01.11.2015, p. 529-541.

Research output: Contribution to journalArticle

Mosier, Jarrod M. ; Hypes, Cameron ; Joshi, Raj ; Whitmore, Sage ; Parthasarathy, Sairam ; Cairns, Charles B. / Ventilator strategies and rescue therapies for management of acute respiratory failure in the emergency department. In: Annals of Emergency Medicine. 2015 ; Vol. 66, No. 5. pp. 529-541.
@article{d192c188aeb34143b8f582412534aabf,
title = "Ventilator strategies and rescue therapies for management of acute respiratory failure in the emergency department",
abstract = "Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60{\%}. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.",
author = "Mosier, {Jarrod M.} and Cameron Hypes and Raj Joshi and Sage Whitmore and Sairam Parthasarathy and Cairns, {Charles B.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1016/j.annemergmed.2015.04.030",
language = "English (US)",
volume = "66",
pages = "529--541",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Ventilator strategies and rescue therapies for management of acute respiratory failure in the emergency department

AU - Mosier, Jarrod M.

AU - Hypes, Cameron

AU - Joshi, Raj

AU - Whitmore, Sage

AU - Parthasarathy, Sairam

AU - Cairns, Charles B.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.

AB - Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.

UR - http://www.scopus.com/inward/record.url?scp=84945489682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84945489682&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2015.04.030

DO - 10.1016/j.annemergmed.2015.04.030

M3 - Article

C2 - 26014437

AN - SCOPUS:84945489682

VL - 66

SP - 529

EP - 541

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 5

ER -