1. Hi Scott,
    great podcast! However- one suggestion- please make it easier to identify the subjects on the download list. I was trying to find the ‘dominating the vent’ on my iPhone, but was unable to locate it as they are listed by podcast episode number. I then went to this site, but it still doesn’t give me a quick way to find out which ‘podcast episode’ I need to go to. I needed it in a hurry to brush up on some of your points on my way to teaching medics, and it would have been nice to have while driving (I was not organized enough to prepare this podcast for listening the night before!). Thanks, Mike

    • Hey Mike,
      I agree this website is great but needs a search bar. I get around that by using google to search only within this site. To do that type your google search query as normal then add a space then type “” (without the quotation marks)
      you will find the podcast you need
      Very hand trick when website don’t have good search functionality – google search usually is better


  2. Hi

    Great podcast. Myself and some fellow consultants listened to it and went about playing with our own vent & talking over your fantastic podcasts. As you probably know UK ED consultants do far less of the anaesthetic workup than you.

    One question- we found that setting up for the high flow rates you describe in the injury strategy meant we had really quite fast inspiratory times and high i:e ratios. Classically in the UK the anaesthetists aim for an i:e of 1.5 to 2.

    That gives us, quite low flow rates! Do you run with much higher i:e ratios?

    • in this circumstance, the flow setting is picked by pt demand. The I:E will vary depending on how high we need to go on RR. Honestly never bother to look at I:E on any patient. I manage my asthmatics with flow graphs and on non-obstructive pts, never bother to look.

      thanks for writing!

  3. hello, Thank you for the lecture, I really enjoyed it, I do have a question, at the end of your lecture, when you were doing your summary you said, “co2 its too high go up on your RR, co2 its too low go down on you RR,
    I believe its the other way around, correct me if Im wrong please, “If you increase your RR (hyperventilation) you blow off Co2 so decreases Co2. and if you decreased RR (hypoventilation) you increase you Co2, again, thank you for your lecture,

    Jaqueline Fernandez-Quezada CCRN

      • Yes, I understood wrong, I thought you said IF YOU WANT your Co2 to go high increased the rate, but you actually said if Co2 iTs too high, my bad, we were saying the same thing, sorry. Great presentation 😉

  4. Magnificent web site. Lots of useful info here.
    I’m sending it to a few buddies ans additionally sharing in delicious. And of course, thanks for your effort!

  5. Hi Scott,
    On our ventilators (PulmonitecSystems LTV1200) we can’t control the inspiratory flow rate, only the inspiratory time. I’m struggling to work out what should this should be set at to be equivalent to an IFR of 60-80L/min. Can you help?

  6. Greeat lecture thx. 1 question: why volume controlled? It is afaik almost universally accepted that pressure control is better. I would go with SIMV

    • Dan, To the contrary I think you will have a hard time finding a single article showing that pressure control is better for patient important outcomes. If you find any, do share. SIMV is also a mode with theoretical but no demonstrable patient-important benefits.

      • SIMV is actually my favourite. With the volume controlled ventilation you have the disadvantage that once the patient’s compliance gets worse you will have very high pressures. But i guess you are right,in the ED there is always someone there to keep an eye on pressures

  7. I can’t THANK YOU enough for this information! Very clear and manageable. Keep up the GREAT work!!!

  8. Question to you Scott about transition ARDS patients with PEEPS in excess of >10cmH2O (PEEP is between 10-20) from ED ventilator to transport ventilator.

    Would you clamp the ET tube when transitioning to prevent the loss of PEEP in ARDS/Sepsis patients?

    Would you give a dose of a paralytic when your ready to make the transition? So patient does not generate NiF with clamped tube, If so what would you use Sux, Roc?

    Or is it a moot point, and not worry about clamping the tube?

  9. Nice summary, Scott. I listened a while ago and thought I’d add this comment to your ultra-simple method.

    At the risk of simplifying too much,here are 2 quick methods I use for calculating starting tidal volume. It is based on the ARDSNet formula for predicted body weight (PBW) where height is the single variable.

    Males = 50 + 2.3 [height (inches) – 60] Females = 45.5 + 2.3 [height (inches) -60] kg

    None of these numbers will come as a surprise to those who regularly select tidal volume using the recommended formula. Since 6-8 ml/kg creates some leeway, combined with predictable height range, it lends itself to some nice round numbers.

    Method 1 (ultra-simple): Males 500 ml Females 400 ml

    This will provide TVol 6-8 ml/kg based on PBW calculation
    Works for males 5’9″±4″ and females 5’5″±3″
    (Metric: males 175 cm±10 cm, females 165±8cm)

    Method 2 300-400 ml + 15ml/in of height >5 feet for males, subtract 30 ml for females

    300 ml is the base TVol for 50 kg @ 6 ml/kg (60 in height)
    400 ml is the base TVol for 50 kg @ 8 ml/kg (60 in height)
    The extra 15 ml for each in of height equates to ~ 7 ml/kg for incrementally increasing height
    (Metric 300-400ml + 6ml/cm over 150 cm, same 30 ml adjust for females)

    This is a combination of basic algebra and some arbitrary rounding for ease of calculation.
    Works for me; other’s mileage may vary.

  10. Bu sitede Havaland?rma ĂŒzerine yap?lan ara?t?rma ve geli?tirme çal??malar? ile mekanikçi arkada?lar gĂŒzel ve faydal? bilgilere sahip oluyorlar. Havaland?rma Sistemleri ĂŒzerine oldukça tecrĂŒbeli arkada?lar?m?z mevcut. Kendilerine buradan çok te?ekkĂŒr ediyor ba?ar?lar?n?n devam?n? diliyoruz.

  11. Dr. Weingart,

    Great lecture! I’m curious about something, at the end of your presentation you had mentioned that sedation was a bonus to your patients on an AC/VC setting, the really important part was to have good analgesia. What would your thoughts be on using precedex, or ketamine for the sedative and analgesic properties in conjunction with low dose fentanyl, with the intent being effective pain control with greater anxiety control without the blunt on neuro status found with a drug like propofol for example?


  1. […] useful charts (partly inspired by Scott Weingart’s ‘Dominating the Vent’ talks: part 1 and part 2) to help you ‘own the OxylogŸ 3000′. They can easily be cut in half, stuck […]

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