Thank you for taking extra effort to illustrate the optimum PEEP just one question looking at the monitor while you were performing your study I noticed that expiratory tidal volume is larger than inspiratory tidal volume, can you give an explanation thanks
so, since we can find out static CL at different peep levels, is there a way to figure out the elastance of a particular pair of lungs so we know how much to stretch it?
hi. great video. One question, in a ADRS patient, when do you recomend to look for a ideal peep? at the ICU admit (just after intubation) or when the patien started to desaturation?
You should measure plateau pressure with a constant flow waveform, and that's only achievable in volume control as you said. You can do an inspiration hold in PCMV, but it is hard to delineate the true plateau pressure when the pressure waveform is constant (as in PC and PRVC).
flow is zero at the end of the inspiration as u can see on the ventilator monitor. So this pressure is plateau pressure (static conditions). U can perfectly estimate the compliance on PCV also
There are several good points to this video, Thanks. However , there are several bad points. Not for the sake of being critical, but for the sake of Patient safety. 1. The importance of Cardiac output should not be glossed over. or should BP be ignored. 2 Both the Peak & plateau pressures were Ignored. 3 This example is done in Pressure Control mode.. The Example might have been more informative done in Volume control , where the pressure changes can be illustrated. 4 As another viewer stated , Other Ventilators don't show the compliance , although one can "guesstimate " by the Pressure Volume loops. But for the less experienced , this might be lost. 5 The Tidal Volumes dropped by over a 100 ml , That is not Good for Ventilation , Not good for Oxygenation. you did mention you would watch the Oxygenation , but did not say how , or what changes you would make if o2 sat dropped. I hope you accept this as constructive criticism. A fellow RCP from California
He makes it perfectly clear that this is about lung mechanics and he is not talking about BP. Yes every RT should know that PEEP decreases venous return secondary to increased intrathoracic pressure. Decreased venous return decreases CO which could decreases BP. Just monitor your blood pressure. Titrate PEEP up to whatever patient can tolerate.
Also just note that this is PCV! So your AW pressures always remain constant (including pplat) and the factors that will change will be volume or compliance. Hopefully if we ventilate at the lower inflection point, our compliance will improve. But also if PEEP is set to low and there is no change in volume, well compliance decreases. Formulas to remember: Driving pressure = pplat - PEEP. Cstat = VT / pplat - PEEP. In PCV, pplat remains constant. So C or V will change.
Thank you! The video is great!
Thank you very much! Great video!
I have learned a lot thanks
Спасибо тебе, мужик! Всё так хорошо объяснил
Useful video; it would be better if they focus on the ventilator screen instead of on the speaker
thank you its a great video
Thank you for taking extra effort to illustrate the optimum PEEP just one question looking at the monitor while you were performing your study I noticed that expiratory tidal volume is larger than inspiratory tidal volume, can you give an explanation thanks
the flow sensor is not calibrated
Thank you it was very informative
so, since we can find out static CL at different peep levels, is there a way to figure out the elastance of a particular pair of lungs so we know how much to stretch it?
Genius. Thank you!
hi. great video. One question, in a ADRS patient, when do you recomend to look for a ideal peep? at the ICU admit (just after intubation) or when the patien started to desaturation?
Great video, sir. Just want to ask...do we need to sedate the patient to do the PEEP study just likw what you did in the video? Thank u
Offcourse we need to heavily sedate the patient to avoid any spontaneous effort, we might have to use muscle relaxant.
thank you!!! its a great video!!!
What is the pip at which I can start lung recruitment by increasng peep??
Can you do this study in PRVC?
excellent video, but I have a doubt. How do you know whats the plateau pressure if the pacient is ventilated by Pressure control and Not in volume???
Pues lo cambias a volumen o consigues un Avea
You should measure plateau pressure with a constant flow waveform, and that's only achievable in volume control as you said. You can do an inspiration hold in PCMV, but it is hard to delineate the true plateau pressure when the pressure waveform is constant (as in PC and PRVC).
flow is zero at the end of the inspiration as u can see on the ventilator monitor. So this pressure is plateau pressure (static conditions). U can perfectly estimate the compliance on PCV also
Tq
There are several good points to this video, Thanks.
However , there are several bad points. Not for the sake of being critical, but for the sake of Patient safety.
1. The importance of Cardiac output should not be glossed over. or should BP be ignored.
2 Both the Peak & plateau pressures were Ignored.
3 This example is done in Pressure Control mode.. The Example might have been more informative done in Volume control ,
where the pressure changes can be illustrated.
4 As another viewer stated , Other Ventilators don't show the compliance , although one can "guesstimate " by the Pressure
Volume loops. But for the less experienced , this might be lost.
5 The Tidal Volumes dropped by over a 100 ml , That is not Good for Ventilation , Not good for Oxygenation.
you did mention you would watch the Oxygenation , but did not say how , or what changes you would make if o2 sat dropped.
I hope you accept this as constructive criticism. A fellow RCP from California
He makes it perfectly clear that this is about lung mechanics and he is not talking about BP. Yes every RT should know that PEEP decreases venous return secondary to increased intrathoracic pressure. Decreased venous return decreases CO which could decreases BP. Just monitor your blood pressure. Titrate PEEP up to whatever patient can tolerate.
Also just note that this is PCV! So your AW pressures always remain constant (including pplat) and the factors that will change will be volume or compliance. Hopefully if we ventilate at the lower inflection point, our compliance will improve. But also if PEEP is set to low and there is no change in volume, well compliance decreases. Formulas to remember: Driving pressure = pplat - PEEP. Cstat = VT / pplat - PEEP. In PCV, pplat remains constant. So C or V will change.
Alberto rodríguez
thank you professor Allan. it´s very informative video
One of the most confusing videos I’ve seen to date.