A given volume (V) will create a certain pressure (P) relative to the compliance (C) of the respiratory system. Volume and pressure are related for a given respiratory system. 1 Because patients remain in the ED while mechanically ventilated, ED clinicians should embrace the established paradigm of pulmonary-protective MV strategies as a cornerstone of care. Increasing evidence has shown that the mechanism of lung ventilation by MV may be as deleterious as it is helpful. The traditional view of MV as a prescription that fits virtually all patients equally should be discarded as a gross misunderstanding of pulmonary pathophysiology. Also, during nights and weekends in some facilities, the ED physician may be called on to troubleshoot or stabilize mechanically ventilated patients in the intensive care unit (ICU). Hospital overcrowding has led to a delay in transfer of mechanically ventilated patients out of the ED, and ventilator management often falls on the emergency medicine physician. It is vital that ED practitioners have a thorough understanding of the basics of MV and to know when to apply these principles and how to support patients in respiratory or cardiac failure. Mechanical ventilation (MV) is an important tool for resuscitation of critically ill patients in the emergency department (ED).
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