Lung protective ventilation (LPV) with tidal volumes of ≤8 ml/kg predicted body weight (PBW) is recommended, however consistent application of LPV in the emergency department (ED) is limited. The research on LPV in trauma is sparse, despite patients being at an increased risk of secondary lung injuries.

Retrospective cohort of traumatically injured adults (≥18 years) who received mechanical ventilation at a rural level one trauma center from (2018–2020). Patients were included if managed with controlled ventilation modes; those extubated, deceased in the ED, or on pressure support were excluded. The primary outcome was the proportion of patients receiving LPV in the ED.

Of 289 patients, 111 (38.4 %) did not receive LPV. Females more often received high tidal volumes (>8 mL/kg PBW) than males (59.5 % vs 31.2 %). In multivariable analysis, height decreased the odds of high tidal volume ventilation (aOR 0.78; 95 % CI 0.73–0.83), while female sex was not independently associated after adjustment. Exposure to high tidal volumes in the ED increased the likelihood of continued high tidal volume ventilation in the ICU (OR 15.3; 95 % CI 7.8–30.1) and operating room (OR 5.6; 95 % CI 2.3–13.5).

LPV was not consistently applied in adult trauma patients in the ED. Exposure to high tidal volumes in the ED was associated with exposure to high tidal volumes in the subsequent operating room and ICU care.