An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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 …
Continue reading Respiratory Management Protocol for SARS-CoV-2 by WeVent
Not every patient reads the textbook, but you and I have to know where to start when managing our patients who have hypercapnic respiratory failure that we want to treat with non-invasive ventilation (or what you and I frequently call BiPAP). This NIV algorithm is taken from the British Thoracic Society/Intensive Care Society Acute Hypercapnic …
Continue reading Non-Invasive Ventilation (NIV/BPAP/BiPAP) Algorithm.
A sentinel event is one where, amongst other different outcomes, leads to death. In critical care, anesthesia, and emergency medicine, we often deal with emergent airways on patients who are on the brink of death unless we intervene expediently. Despite having performed many intubations in my young career, I have the utmost respect for every …
Continue reading Pre-oxygenation: High flow nasal cannula vs. BVM
This was a post-hoc analysis of the FLORALI trial that I have reviewed before on this medium. In that study they compared patients who had hypoxemic respiratory failure by putting them on 1:1:1 on high flow nasal cannula (HFNC), standard oxygen therapy, and non-invasive ventilation (NIV aka BiPAP). They found that BiPAP was not beneficial …
Continue reading BiPAP should not be used in Immunocompromised patients
I've reviewed numerous mechanisms of action and functions of High Flow Nasal Cannula (HFNC) but I haven't touch on whether or not it works to help ventilate patients. I have discussed in the mechanisms of action that it does wash out the CO2 from the dead space in the nasopharynx, oropharynx, etc, but does that …
Continue reading High Flow Nasal Cannula (HFNC): Does it Ventilate COPD Patients?
Fortunately in the critical ill population, we do not necessarily have to abide by the saying that "if all you have is a hammer, everything looks like a nail". What I'm referring to is regarding utilizing high-flow nasal cannula in acute heart failure exacerbations. I already dissected how HFNC generated a "PEEP" equivalent airway pressure …
Continue reading High Flow Nasal Cannula in Acute Decompensated Heart Failure
High-flow nasal cannula oxygen therapy in adults Some of you have asked what I mean every time I post something regarding high flow nasal cannula. Let's start by defining the flow in the different oxygen devices. Regular nasal cannula provides between 1-6 liters of flow. A simple face mask can get you flows between 6-10L/min. …
This study was the first randomized control trial looking at whether high-flow nasal cannula (HFNC) decreases the need for mechanical ventilation in the emergency department. In addition they looked at emergency department and hospital lengths of stays, 90 day mortality, adverse effects in the hospital, and patient experience. I sympathize for the authors of this …
Continue reading High Flow Nasal Cannula in the Emergency Department: Avoid Intubations
I have extensively covered high flow nasal cannula, HFNC on this page due to a talk I'm creating on the matter. We've witnessed it first hand keep patients off of the ventilator. This article published in the American Journal of Respiratory and Critical Care Medicine, which as an aside is the highest impact factor publication …
Continue reading High Flow Nasal Cannula: Physiologic Effects
Please note that I have sorted out this issue and the following rant is a rant on my thought process leading up to my eventual resolution looking at PEEP and high flow nasal cannula. I was trained, or maybe even made it up in my head, that for every 10L of flow increase on the high …
Continue reading HFNC/High Flow Nasal Cannula: Does it generate “PEEP”?