Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-2: Mechanical Ventilation II Rounding: Putting Principles into Practice (Khalilah L. Gates, MD)

2: Mechanical Ventilation II Rounding: Putting Principles into Practice (Khalilah L. Gates, MD)

Video Transcription

Video Summary

The video discusses the principles and practice of assessing the effectiveness and safety of mechanical ventilation strategies. The speaker emphasizes the importance of three questions when rounding on ventilated patients: Are the settings safe and effective? Is the patient synchronous with the ventilator? And if they improve, is it appropriate for a spontaneous breathing trial (SBT) ? The video further explains what is considered safe and effective settings for ventilating patients, such as maintaining arterial blood gases within target ranges and avoiding lung injury. The concept of stress and strain of the lung and how the choice of ventilator settings can contribute to ventilator-induced lung injury are discussed. The importance of minimizing both tidal stretch and maximal stretch is emphasized. The use of low tidal volume ventilation and reduction of plateau pressures are recommended to decrease mortality in ARDS patients. The video also provides an overview of different types of ventilator asynchrony and the impact they can have on patient outcomes. Lastly, the speaker explains the criteria for ventilator discontinuation and the use of spontaneous breathing trials to assess readiness for extubation. The video concludes with recommendations for weaning patients to high flow oxygen therapy or non-invasive ventilation after extubation.

Keywords

mechanical ventilation

ventilator settings

synchronous ventilation

spontaneous breathing trial

ventilator-induced lung injury

ARDS patients

ventilator asynchrony

ventilator discontinuation criteria

high flow oxygen therapy

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