Episode 2 – Mechanical Ventilation

Episode Overview:

  1. What are Indications and contraindications to NIPPV?
  2. Describe your initial BePAP or CPAP settings?
  3. What are good initial vent settings?
  4. How  do you troubleshoot the crashing patient on the ventilator?

Episode 2 Show Notes

6 thoughts on “Episode 2 – Mechanical Ventilation”

  1. Guys,

    Love the podcast. I will definitely be disseminating to our students and residents. I’m amazed with how much you were able to cover on this huge topic in 10 minutes. A couple of minor “beyond Rosen’s” pearls:

    1. Consider the patient’s physiology when choosing your initial ventilator settings. If the patient is intubated simply for airway protection, the default AC/VC rate 12-14, tidal volume 8 cc/kg, PEEP 5 is totally fine. If your patient has severe hypoxemic respiratory failure due to ARDS, drop that tidal volume and increase your rate. Great job covering obstructive lung disease and severe metabolic acidosis. These are common misses that I see regularly as an ICU fellow.

    2. Regarding above, check early to see if your guess (regarding vent settings) was correct. A prompt ABG (or VBG + O2 sat) within 5-15 mins of a vent change will let you know if you made accurate assumptions about your patient’s physiology.

    3. Don’t forget the small stuff to prevent further harm. Simple measures like elevating the head of bed, gastric decompression, and oral decontamination have all been shown to reduce the incidence of ventilator associated pneumonia, which is highly morbid. Do what you can in the ED to prevent this dreaded complication.

    Again, phenomenal work. I look forward to listening to many more.

    1. Great Points!!!

      Sadly we didn’t have tons of time to cover that, so thanks for the backup! We will be covering specific vent management issues in subsequent chapters.

      Keep the feedback and discussion coming!

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