Use of protective lung strategies in the management of mechanically ventilated adult emergency department patients: A cross sectional survey

Sarah Cornish1, Rochelle Wynne2, Sharon Klim3, Anne-Maree Kelly4

1 Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021,
2 School of Health Sciences, University of Melbourne, Parkville, VIC 3010.
3 Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021
4 Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital. 176 Furlong Road, St. Albans, VIC 3021

Background: Mechanical ventilation (MV) is a therapeutic intervention used in emergency departments (EDs) that has associated complications such as lung trauma and the development of acute respiratory distress syndrome (ARDS). In the last decade there has been increasing interest in the use of protective lung strategies (PLS), comprised of low tidal volume (6mL/kg) delivery, control of fraction of inspired oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) to reduce risks associated with MV. Australian ED nurses share ventilation decision-making with their medical colleagues. However, there is very little evidence describing nurses’ knowledge or application of PLS. The aim of this research was to determine clinical practice patterns and nurses knowledge regarding the implementation of PLS in the ED.

Methods: The study used a descriptive, exploratory design and online questionnaire. A convenience sample was recruited via the College of Emergency Nursing Australasia mailing list and snowball sampling. A three-part questionnaire was designed to identify demographic data, information on clinical practice patterns and nursing knowledge of PLS via validated case scenarios.

Results: The survey was completed by 157 nurses and PLS are being used in many EDs (n = 104, 75%). Clinical practice guidelines for mechanical ventilation were accessible to 62% (n =86) of participants. Formal tools are used by many clinicians to determine optimal tidal volume (n = 112, 80%). Nurses knowledge of PLS was sound and components of decision-making in relation to PLS consistent, however level of confidence and perceived autonomy when implementing PLS in the ED varied.

Conclusion: PLS are being used in Australian EDs in the clinical care of mechanically ventilated patients, which aligns with best available evidence. Australian ED nursing staff have good levels of knowledge of this approach to MV. There is a need for standardised evidence-based clinical practice guidelines that may improve nurses’ confidence in implementing such strategies, and also provide a benchmark for future clinical practice to facilitate the generation of evidence on this topic. Development of such a guideline may pave the way for ED nurses to independently manage invasively ventilated patients which presents an innovative approach to care delivery of these highly complex patients.


Sarah Cornish has been a passionate ED nurse for over 14 years and is working in the dual roles of Clinical Nurse Educator and Clinical Nurse Specialist in the ED at Sunshine Hospital, Melbourne, Victoria. Sarah has recently finished her Masters in Advanced Nursing Practice, by Minor Thesis, and has a particular interest for mechanical ventilation in the ED. Sarah was also awarded the honour of being the CENA Emergency Nurse of the Year in 2015.