Mechanical Ventilation Rounds

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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Airway occlusion pressure (P0.1)

Irene Telias MDCritical Care FellowSt. Michael’s Hospital and University Health NetworkInterdepartmental Division of Critical Care MedicineUniversity of Toronto 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…

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Expiratory Flow Limitation (EFL)

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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Interpret This Waveform Pattern

The results are in!   There were multiple correct responses.  The patient indeed has high resistance as shown by the large difference between peak-inspiratory pressure (PIP) and plateau pressure (Pplat).  They also have significant expiratory flow limitation as suggested by the shape of the expiratory flow-time curve (methods for assessing EFL will be included in another…

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Flow Starvation

Flow starvation is a form of patient-ventilator dyssynchrony that occurs when a patient is demanding more flow than the ventilator provides.

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Short Cycling

Short cycling is a common form of patient-ventilator dyssynchrony. It occurs when a patient-triggered breath cycles off prior to the patient effort being completed.

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