Steve, Dan, and Holly introduce their guest speaker, Kari, a respiratory therapist/paramedic from Washington. Kari discusses the endotracheal tube and the importance of having a correctly sized and placed tube. Kari highlights how critical it is to understand the disease processes that resulted in the patient being intubated. Ventilation and oxygenation issues are reviewed, along with the importance of PEEP in intubated patients.
Kari talks about PEEP in intubated patients with asthma or COPD, as well as variations in tidal volume settings for various disease processes. The group discusses minute volume, and how a patient’s minute volume is calculated on the ventilator. Kari discusses her process of titrating ventilator settings to meet a CO2 goal. Do no harm is reviewed in relation to mechanical ventilation, and the consequences of a patient working against the ventilator are discussed.
Assist control (AC) and synchronous intermittent mandatory ventilation (SIMV) modes are compared. Kari details what modes she prefers for specific patient presentations and disease processes. The group discusses volume and pressure control, and review a trauma scenario where the patient is intubated. Peak inspiratory pressure and peak alveolar pressure are reviewed, along with what abnormal values can indicate. The importance of driving pressure is highlighted. The PF ratio is discussed, along with the importance of weaning patients off of 100% FiO2.
The group ends on discussing appropriate IE ratios in obstructive patients. The flow rate in both volume and pressure control is reviewed, as well as the effect of flow rate on a patient in both volume and pressure control settings. Another scenario is discussed, a COPD patient that has been intubated. Kari walks through troubleshooting tactics for ventilators and potential fixes for common issues with mechanical ventilators.