rsbi

RSBI (Rapid Shallow Breathing Index) for Extubation Success? Nope.

With so many simultaneous issues transpiring in our critically ill patients, it is naive to think that one lab marker or one calculation would tell an absolute story. This has led to the erroneous mindset that every time the lactate is elevated, the patient has sepsis when we know that is not true. Another such …

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expectations covid

Expectations for Families of COVID-19 Patients on the Ventilator

On 8/9/21 I put out a tweet discussing (in a certain limited number of characters) how difficult it is to get a patient who is intubated and placed on mechanical ventilation because of severe COVID-19 ARDS. I used the analogy of landing an airplane in a hurricane. Definitely not easy. Something came over me where …

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Driving Pressure in ARDS: Improving Survival By Any Means Necessary

Patients placed on mechanical ventilation carry a certain mortality by default. Obviously it is not a good thing to end up intubated in the ICU. It's one thing to set up a patient on mechanical ventilation and then just twist the knobs to get a pretty arterial blood gas that's satisfactory to keep the patient …

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double triggering

Double Triggering and Ventilator Asynchrony/Dyssynchrony

Let's start off by defining double triggering. No, it's not saying two things interpreted as inflammatory to someone back to back while they lose their minds. These are strange times we live in. I digress. Double triggering is something that occurs to patients who are mechanical ventilation. The lay person would interpret this as the …

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Hypercapnic Respiratory Failure: Tricks for Ventilator Management

Those of us who are in the ICU, especially those of us taking care of the patients caught up in this pandemic have learned that certain patients can be quite challenging to oxygenate and ventilate. For the uninitiated, the whole purpose of mechanical ventilation is to be a band-aid of sorts for patients who we …

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Choosing Wisely: Daily Chest X-ray while on Mechanical Ventilation

I am thrilled the Choosing Wisely Campaign has looked upon this data. Upon my first foray into the ICU as a PGY-1 many moons ago, we would not be able to go home until we put in orders for all of our patients. Amongst those things that we would order daily included chest x-rays for …

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Respiratory Management Protocol for SARS-CoV-2 by WeVent

The WeVent team came together to create this respiratory management protocol to help us take care of patients with COVID-19. First of all, a big hat tip to the authors: Aurio Fajardo C; MD. Medicina Interna. Unidad de Paciente Crítico. MsC en Ventilación Mecánica, Universitat de València. MsC en Medicina Intensiva. Grupo Ventilación Mecánica Chile …

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Multiple Patients on a Ventilator: FAIL

Sometimes medicine behaves like the stock market; a whole bunch of enthusiasm followed by a realistic pullback. This has now occurred with the concept of using one ventilator for multiple patients. I agree that we need to use some ingenuity in this crisis, but this one never sat well with me, hence me not commenting …

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covid extubation protocol

COVID-19 Extubation Protocol (in the works)

Many questions on how to extubate these patients. There's no right answer yet. I've read of a high reintubation rate for these patients and cardiac arrest after extubation we need to be prepared for that. This is a living, breathing document. I would like to make changes as you all point out things that I have missed. Let's attempt …

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