Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
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- EMCrit 301 – The Five Fears with Rob Orman (Mind of the Resuscitationist) - July 1, 2021
great input!
experienced exactly the same phenomenon although collectively aimed at higher peeps, but failed to be consequent enough. So we ended up with rescue settings down to 2 sec phigh. And the question why not „playing on the upper part of the curve“ right from the beginning.
one question: where do I find the „ratchet theory“ Scott mentioned? Any paper or talk where habashi suggests this mechanism?
will need to bring him back on to discuss
It is clear to me that Scott, Rory and David are the tip of the spear here and I appreciate your willingness to frankly discuss what is an evolutionary way of treating Covid-19 patients. I trust you guys completely and so appreciate your leadership
Is there any role in this strategy for Flolan? Would this assist with pulmonary dilation and also for the inflammatory response in the vasculature?
was mentioned at the end
I have to admit, this round table makes me angry. I’m a critical care doc in one of the busiest Covid units in my city, and I have never received training in how to use APRV. To be honest, I’m not sure I’d heard of the mode until these recent posts about it. I did a Pub-Med search about it and found the one Zhou article describing miraculous results (and read Josh’ post about that article). Then… crickets? (Well, there was this one cautionary study: https://pubmed.ncbi.nlm.nih.gov/31243221/?from_term=aprv&from_pos=4). If this mode is as good as the Zhou article claims, why has it… Read more »
Amanda,
Love that comment. THe Zhou article puts APRV amongst the most studied modes. We have no evidence head to head on any of the others that is any good. That being said, we need a ton more evidence in this realm.
20:50 mark – What was the type of shock that you mentioned? Or was it an adjective I couldn’t make out?
Thank you all for this encouraging discussion.
Interested to hear that patients are “happier with APRV”.
When a local intensivist said something similar to me a few years ago I reflected that there must be something in this Habashi APRV (TCAV) strategy.
It takes a lot of fiddling on our ED ventilators to achieve what should be simple; Amanda’s experience rings true – when will the (less fully optioned) vents just have an APRV button which allows the parameters to be set?
David and Amanda
It is worse than that! Even if you can get those vents to do APRV, it is not real APRV b/c the valves are crappy and the pt experience is miserable. If you are going to do APRV you need a vent that is built for it, not tacked on.
Great article it sure wouldn’t come at a better time. Thanks!