Management of Mechanical Ventilation in Emergency Medicine: A Scoping Review.

Objectives: Invasive mechanical ventilation is used for approximately 250,000 emergency medicine (EM) patients annually and continues to increase. Despite rising volumes, EM clinicians receive limited training in ventilation management. Much of the existing evidence is derived from other environments, which may not fully apply to the unique conditions of EM. This scoping review broadly categorizes literature on invasive ventilation specific to EM patients and clinicians and identifies knowledge gaps to direct future research. Methods: Following Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews Checklist guidelines, this review comprehensively mapped the literature on optimizing invasive mechanical ventilation in EM. Studies involving EM patients or clinicians were included. Searches in MEDLINE, EMBASE, and CINAHL identified relevant studies, which were screened and data were extracted by multiple reviewers. Identified studies were analyzed and categorized thematically. Results: From 4386 articles, 65 studies met inclusion criteria. Studies focused on EM patients (54 studies) and clinicians (11 studies). The following 6 themes emerged: tidal volume management (32 studies); ventilator adjustments (15); sedation and neuromuscular blockade (15); education, knowledge, and assessment (10); bundled care (8); and oxygen/carbon dioxide management (8). Some studies fit multiple themes. The variability of study methods and topics precluded synthesis of data; however, some key results were found in the most studied themes. Specifically, ventilation bundles that include low tidal volume ventilation may be associated with reduced mortality. Sedation practices were highly variable, and achieving lighter sedation in EM patients may be an ideal target for future study. Additionally, EM clinicians lack training and comfort in managing invasive mechanical ventilation. Significant gaps in EM-specific evidence and variable adherence to recommended practices were also identified, highlighting opportunities for improved education and care strategies. Conclusion: Limited research exists on invasive mechanical ventilation management in EM. Although strategies like tidal volume restriction show promise, evidence specific to the EM setting remains sparse. Further research is required to identify critical interventions to improve outcomes for emergency patients.