When I was a resident, every vent lecture either put me to sleep or left me dazed and bewildered. I gave a lecture of that ilk when I started working after fellowship. I had become part of the problem. I decided there must be a way to make vent management more understandable and if not interesting, at least bearable.
This lecture was up on the soon to be defunct EMCrit Lecture site. It offers a path to managing any patient on the ventilator in the ED. I have tried to simplify as much as possible while still maintaining an evidence-based approach.
This is Part II, it deals with the obstructive strategy. Last week, we spoke about the strategy for patients with lung injury.
Your goal with these patients is to let them have adequate time to breathe out.
There are only 4 things you need to remember for an obstructive patient
Vt (Tidal Volume) = 8 ml/kg, don't mess with it
Flow Rate = 60-80 lpm, shortens insp times (this really doesn't do much good, and super-high IFRs should not be used. Increasing IFR will also increase peak pressure)
Resp Rate = Lung protection, start at 10 work your way down if necessary
FiO2/PEEP = Oxygenation, should need much O2 (40%)m I recommend PEEP of 0, but certainly keep it less than 5
First Print out this Handout
If you need just the audio [right or cntrl click here]
- COVID19 – Awake Pronation (aka the Pig Roast) A guest write-up by David Gordon, MD - April 6, 2020
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020