Mechanical Ventilation

What Is Mechanical Ventilation?

Prehospital mechanical ventilation involves using an automated portable transport ventilator (such as the Revel or Zoll Z Vent) to deliver controlled tidal volumes, breath rates, and PEEP (Positive End-Expiratory Pressure) to intubated or SGA-managed patients.

Why Mechanical Ventilation Matters on the Fireground

Manual BVM ventilation during transport frequently leads to hyperventilation (blowing off too much CO2) or gastric inflation. Automatic transport ventilators deliver precise tidal volume (6–8 mL/kg) and oxygen concentrations, protecting lungs from barotrauma.

Relevant NFPA Standards

• NREMT Standards: National Registry of Emergency Medical Technicians Practice Standards
• NFPA 455: Standard for Emergency Medical Services (EMS)

Field Procedures & Tactical Steps

1. Confirm endotracheal tube placement with ETCO2 capnography before connecting ventilator.
2. Select initial ventilator settings: Volume Control mode, Tidal Volume 6–8 mL/kg IBW, Rate 10–12 bpm, PEEP 5 cmH2O.
3. Connect ventilator circuit to ETT/SGA and monitor peak inspiratory pressure (PIP < 30 cmH2O).
4. Troubleshoot sudden alarm spikes using the DOPE mnemonic (Dislodgement, Obstruction, Pneumothorax, Equipment failure).
5. Re-assess SpO2, ETCO2 waveform, and blood pressure after every setting modification.

Common Context & Application

Utilized during inter-facility critical care transports, post-cardiac arrest care, severe respiratory failure, and head injury management.

Frequently Asked Questions about Mechanical Ventilation