Ventilation Pearl: The Missing Instrument...


  • Studies have shown that physicians do not accurately estimate patient body weight.
  • Using a tape measure to obtain an accurate height can prevent the hyperventilation that occurs in almost 20% of patients intubated in the ED.
  • A patient's lung capacity correlates with their lean body mass; a function of height and gender rather than true body weight.
  • The ARDSnet ideal body weight/tidal volume chart takes all of the calculations and guesswork out of selecting the appropriate tidal volume for your vent settings.  Consider keeping a copy on your airway cart!
  • 6-8cc/kg IBW is the recommended initial tidal volume.



  • Lung protective measures need to start in the ED, as acute lung injury and ARDS can develop in as few as 5 hours in at risk patients.





  • Goyal, M. Bhat, R. Tefera, E. Frohna, W. Body mass index is associated with inappropriate tidal volumes in adults intubated in the ED. American Journal of Emergency Medicine. 34 (2016): 1673-1730.

  • Stehman, C.R. et. al. Bedside Estimation of Patient Height for Calculating Ideal Body Weight in the Emergency Department.  The Journal of Emergency Medicine. 41;1 2011: 97-101

  • Sacchetti, Al. “Community Medicine Rants – Tape Measure Ventilation” Audio blog post. EM:RAP. March 2017.

  • Ventilator Protocol Card. NHLBI ARDS Network. 2008.

  • Fuller BM, Ferguson IT, Mohr NM, et al. Lung=Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Annals of Emergency Medicine. 2017.