Podcast 114 - Vent Strategies & Metabolic Acidosis w/ Bryan Winchell

Yesterday I posted the blog "Ventilation - Playing Defense." The blog addressed the reasons why we don't want to intubate a patient in metabolic acidosis, the correlation between VBG & ABG, and the importance of knowing your ETCO2 to PaCO2 gradient.

In part two of this discussion (the podcast), Sam and I invite Bryan Winchell on to discuss the logistics of actually setting up the ventilator and settings that we think are helpful.

1. Optimize volume first and then take advantage of the "no-flow" zone to add in breaths.

2. The width of your flow waveform will tell you whether or not more inspiratory time will = more volume.

3. These patients typically don't need a ton of PEEP because they are spending such a short time exhaling (due to fast rate). PEEP of zero is probably ok because pressure will likely never truly get to zero. If a PEEP of zero gives you visceral pain, 3-5 mmHg is a good spot to start. Watch the flow/pressure waveform in this video (also demonstrates why ASV may be a decent option).

Now check out the podcast where we discuss all this and more.