VentMonkey
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Feel free to slide me a pm if you have any questions about Creighton's CCP course.I am highly interested in CC and plan on doing a UMBC or Creighton course, hopefully soon.
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Feel free to slide me a pm if you have any questions about Creighton's CCP course.I am highly interested in CC and plan on doing a UMBC or Creighton course, hopefully soon.
Aw I am late to the party. Awesome case, reexpansion pulmonary edema is interesting. Pretty rare in my experience.
Will do, thanks.Feel free to slide me a pm if you have any questions about Creighton's CCP course.
Pmean should NOT go above 30
View attachment 3223
No... think "fluffy infiltrates"
So I definitely agree with paralyzingly. Paralyzingly will decrease metabolism due to the muscles not exerting any energy, allowing for less oxygen consumption.
In the above quotes I mentioned that at a PEEP of 12 and a Pressure Control of 15, you probably have a plateau of 25.
How'd you come by that number?
Cool, thanks.You mean the plateau pressure, not the mean, I think. The mean airway pressure is not usually used when evaluating lung protection.
Please explain plateau pressure.....Admittedly, I didn't do the math on it, just relied on experience with ventilating restrictive lungs.
The point isn't necessary the exact numbers but the concept surrounding them. Since the PC is 15 and the Peep is 12, then PIP would be 27. The closer the plateau pressure to the peak, then it suggests a decrease in compliance. In other terms, when there has been a decrease in trans pulmonary pressures, there is often a decrease in compliance. A lung like this suffering from reinflation pulmonary edema isn't going to be very compliant at all.
Admittedly, I didn't do the math on it, just relied on experience with ventilating restrictive lungs.
The point isn't necessary the exact numbers but the concept surrounding them. Since the PC is 15 and the Peep is 12, then PIP would be 27. The closer the plateau pressure to the peak, then it suggests a decrease in compliance. In other terms, when there has been a decrease in trans pulmonary pressures, there is often a decrease in compliance. A lung like this suffering from reinflation pulmonary edema isn't going to be very compliant at all.
True, but you're thinking about it the way you would in a volume-targeted mode (e.g. VC). In PC, in principle, flow should decrease toward zero at the end of the breath, with the result that the peak pressure is actually equal to the plateau pressure.
In reality, if inspiratory time is not set long enough, it often fails to reach zero, leaving some residual gradient between peak and plateau. But that will largely be determined by time.
View attachment 3235
Yeah I've only seen it once. Although probably a little too aggressive, indenpendent lung Ventilation would be a great option here as well.
Did you mean to say that was what was going in in the CXR you posted? That sure looks like a L DLT there to me.