Difficulty Ventilating: A Case Report on Ventilation Considerations of an Intubated Asthmatic Undergoing Air Medical Critical Care Transport

Published:December 15, 2020DOI:


      • Transport ventilators have technical limitations on peak inspiratory pressures.
      • The patient's current ventilator settings must be considered before the launch of an aircraft.
      • Extracorporeal membrane oxygenation should be considered in cases of status asthmaticus and cardiovascular collapse.
      • There may be some utility in considering alternative “rescue” modes of ventilation during transport.


      The air medical transport of intubated patients is a high-risk mission that requires preplanning before helicopter launch. This case describes a scenario in which the helicopter emergency medical services (HEMS) team was unable to ventilate a patient because of the mechanical limitations of the transport ventilator. The HEMS mission was ultimately aborted, and the patient had to be transported by a ground crew equipped with a hospital-based ventilator. In addition to the optimal medical management of the patient in status asthmaticus, critical care transport crews must be familiar with the treatment of patients exhibiting extremely high peak airway pressures. Specifically, ventilator manipulations as well as the technical specifications of the transport ventilator may preclude the patient from being transported by the HEMS team. It is imperative that the patient's current ventilator setting be evaluated before the launch of the aircraft to prevent any possible delays in patient care.
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