Ventilator management: A practical approach to respiratory failure in combat casualties

The survival of combat casualties from the point of injury to definitive medical care has significantly improved over the last decade. Survival is >95% for casualties who survive their initial injury and are evacuated to definitive care. This improvement can be credited to several factors, including advances in body armor, an improved skill set of prehospital personnel, the presence of forward surgical teams, the availability of surgical and critical care assets in austere environments, and deployment of an increased number of soldiers skilled in basic and advance trauma life support. Early and effective management of battlefield casualties can be successful when the basic principles of prehospital, trauma, and critical care are maintained throughout the entire medical evacuation process. A critical care-trained physician may not be available to treat casualties; thus, all deploying physicians should be familiar with principles of respiratory failure and ventilator management.