Based on the recently published paper “Impact of Respiratory Rate and Dead Space in the Current Era of Lung Protective Mechanical Ventilation”, we will discuss here briefly the different part of the dead space and how it can be reduced, as well as the relations with respiratory rate, tidal volume and alveolar ventilation (part 2).…

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Protective mechanical ventilation should be implemented after intubation in ARDS and in non ARDS patients, and in COVID-19 patients with pneumonia. However, protective ventilation does not just mean tidal volume reduction and we would like to focus here on the respiratory rate and the instrumental dead space. Based on the recently published paper “Impact of…

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Pressure Support Ventilation is one of the most commonly used modes of assisted ventilation during the weaning phase. In patients who are recovering from the acute phase of both obstructive and restrictive lung diseases, monitoring respiratory effort and the total pressure distending the respiratory system is of invaluable help in order to maintain a “protective”…

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Reverse triggering is a type of dyssynchrony that occurs when a patient effort occurs after (‘is triggered by’) the initiation of a ventilator (non-patient triggered) breath.  Usually, it is a phenomenon occurring over many consecutive breaths and also referred to as ‘entrainment’. Diagnosis The visual detecting of reverse triggering is slightly different between modes of…

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What is the most likely form of asynchrony causing this waveform? Voting has ended, view the full write up on Reverse Triggering.

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Bedside Mechanical Ventilation Rounds are an excellent way to strengthen clinical knowledge of the subject. In this post we describe the rounds and provide tips for implementation in your institution.

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Case vignette 56 yo gentleman recovering from severe ARDS, muscle paralysis was discontinued 24hrs ago. Still on continuous sedation with Propofol and Midazolam. Clear “asynchrony” on the ventilator with frequent double cycling. Oxygenation has worsened in the last 6 hours. You go to the bedside and find: What maneuver can help you understand the underlying…

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Expiratory flow limitation (EFL) is often associated with the presence of auto-PEEP. There are simple bedside maneuvers that can be done to determine the severity of EFL. For this subject, the CoEMV invited Detajin Junhasavasdikul MD, first author of a paper on the subject published in Chest, 2018.

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