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Analysis of Initial Emergency Department Ventilator Settings in Accordance with Ability to Oxygenate
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DOI：10.1016/j.jemermed.2026.01.022.png)
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Abstract
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Background In most emergency department (ED) patients, mechanical ventilation is initiated with limited data. Ability to oxygenate is usually available and could indicate acute respiratory distress syndrome (ARDS). Objective To determine if patients' ability to oxygenate is associated with initial ventilator settings. We hypothesize that severely hypoxemic patients were exposed to similar initial settings compared to those oxygenating normally. Methods Retrospective chart review of adults intubated in nine EDs in 2019. Partial pressure of arterial oxygen (PaO2):fraction of inspired oxygen (FiO(2)()) (P:F) was calculated based on postintubation arterial blood gas (ABG) and concurrent ventilator settings. Patients were grouped into severe hypoxemia = P:F <= 100 and normal oxygenation = P:F > 300. The primary outcome was the association of oxygenation group with initial Tidal Volume (V-T), FiO(2) and positive end-expiratory pressure (PEEP). Group differences were analyzed using chi-square for categorical variables and Wilcoxon rank sum for continuous data, following normality testing with Shapiro Wilk. Results Of 1995 adults intubated, 175 were severely hypoxemic and 578 had normal oxygenation yielding a cohort of 753. Severely hypoxemic patients were more likely white, female, and had a higher body mass index (BMI). They were initiated on similar V-T (7.0 [6.3-7.9] vs. 7.0 [6.4-7.8] mL/kg/ideal body weight [IBW]; p = 0.94), higher PEEP (5 [5-8] vs. 5 [5-5] cm H2O; p < 0.0001), and more likely to be placed on 100% FiO(2) (81% vs. 53%; p < 0.0001). Conclusion Initial PEEP and FiO(2), but not V-T differ based on a patient's ability to oxygenate. Most severely hypoxemic patients were started on a PEEP of 5 and most normally oxygenating patients were started on 100% FiO(2). (c) 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/)
Keywords:
rapid sequence intubation
initial ventilator settings
PEEP
tidal volume
fraction of inspired oxygen
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