MECHANICAL VENTILATION DURING CRITICAL AIR TRANSPORT

BACKGROUND & INTRODUCTION

a. Mechanical ventilation can injure the lung. Appropriate ventilator strategies will minimize ventilator induced lung injury.

b. Lung protective ventilation is appropriate for most CCAT patients, even if they do not have Acute Respiratory Distress Syndrome (ARDS).

i. While many patients transported by CCATT who are mechanically ventilated may not meet diagnostic for ARDS, similar pathophysiologic processes such as alveolar overdistention (volutrauma), barotrauma, atelectrauma, and inflammation are likely at work.

ii. In patients at risk for ARDS, a lung protective ventilation strategy reduces the risk of developing ARDS

c. This document closely follows the ventilation strategy from the ARDS Network ARMA trial.

i. This is the least harmful strategy formally studied and validated in a large trial.

ii. Some experts may choose to deviate from the strategy in an individual patient.

iii. The strategy has been modified in some respects to simplify its use.