WeVent

We recently released Essentials of Mechanical Ventilation, a free online resource for clinicians and students working with COVID-10 patients. Learn more about this resource today!

The answer: Early cycling it is! How do you deal with it? #VentRounds @CCF_PCCM @CleClinicRespir #FOAMed #SoMe4MV

What is the patient-ventilator discordance

Refer to Lesson #5 on @we_vent for breakdown of the mode PRVC including the pros and cons! @CCF_PCCM @SMHCoEMV @MayoPCCM @SCCM #EMCritCare #pulmcc

So important to recognize the nuances of managing #ventilators in all patients, including those with #COVID19. You cannot safely just “set it and forget it”. See below for a breakdown of patient-vent discordance illustrated by @emireles_c @CleClinicRespir #ModesWithLimitations

Can plateau pressure be higher than peak pressure? Read 👇 #WeVentWednesdays @some4mv

5/Good for patients with significant asynchrony and/or chronic respiratory failure. Not used for short term ventilation, HD instability or heavily sedated. In COPD patient in PSV, increased pressure--> more intrinsic peep & increased difficulty triggering --> resultant decr RR

4/ PRO/CONS: Does not require addition hardware (like NAVA) Not available on all vents Invasive and noninvasive ventilation Patients > 20kg Does not resolve intrinsic peep Improves synchrony

1/ Lesson#9: Proportional Assist Ventilation (PAV) #WeVentWednesdays #WaveformsMatter @CritCareMed @some4mv #FOAMed References: bit.ly/2FBwmMA bit.ly/36Cb7Gz bit.ly/2N7diu7

Wolbrink et al : GamER Study-residents had superior knowledge acquisition with virtual ventilation simulator before PICU rotation. Link:ow.ly/ETvI50xA3Ne @sccm #CritCareMed #MedEd Fig : Change in test scores throughout the study by arms

7/Waveform analysis with NAVA (upper panel) & PS (lower panel). Note dyssynchrony in lower panel with ineffective triggering & pressure and flow waveform not matched to neural EAdi waveform Further reading: bit.ly/2rOpkRG bit.ly/2QynDAc bit.ly/356EGOY

6/Goal of setting NAVA level: unload the increased effort of resp muscles Techniques: 1) stepwise uptitration to achieve inflection point on curve below – Brander et al OR 2) set @ 60% of highest EAdi during SBT w/ 7cmH20 in PSV & retest daily until extubation – Roze et al

1/Happy New Year WeVenters! Looking forward to an educational & productive 2020! Lesson#8:Let’s start off with a lesson on Neurally Adjusted Ventilatory Assist (NAVA) References for this lesson: bit.ly/36pWXbe bit.ly/2rKKXST

Additional resources: bit.ly/2NKzRoT bit.ly/34Vv9KI bit.ly/350OVVc bit.ly/32Ltx4W Check out this video! youtube.com/watch?v=-rgrBt…

Advantages and Disadvantages in APRV Weaning APRV with “Drop and Stretch” – reduce P high and increase T high until reaching CPAP

1/ Lesson#7: Airway Pressure Release Ventilation (APRV) #WeVentWednesdays #WaveformsMatter @CritCareSociety @ATSCritCare @CritCareMed #EMCritCare #PulmCC #AnesCritCare #FOAM Lesson based on and modified from bit.ly/33NAnYP