Basic Principles of Mechanical Ventilation

[@rekitabarnes1747]

LIsten!!!! you need a grammy for being the hands down best teacher!!! MY class all the way in Macon GA lives by your every single word!!!!!!!!!!!!!!!!!!!!!!!

[@cody1429]

Man, you're a blessing. Because of covid I am having to do mechanical ventilation completely online and basically teach myself. The only classes we do face to face currently are labs and clinicals.

[@RespiratoryCoach]

Hey, Cody! Same here for my students. Glad you found the video helpful. Reach out anytime and thanks for watching!! Keep up the strong work!

[@Vijay-em8ut]

Where did you study ?

[@cody1429]

@@Vijay-em8ut Valencia CC in Orlando. I graduated 2 years ago.

[@kimberlyhouseworth4711]

@@cody1429I am at Valencia CC now for RT! I start Mechanical Ventilation in the fall

[@stigmatamartyr4223]

That happened to my class. We got hit during Covid and had to do online classes. Even did our graduation online 🥴 A lot of us struggled with the board exams

[@gabbybrown456]

I’m so grateful to have your videos as a resource

[@quaintonquaint5486]

I am on summer break and when our 3rd semester starts back we get into advanced vent so this is truly a helpful video for brushing up on key concepts, thank you!!

[@farah5804]

You're a superb teacher on respiratory management

[@RespiratoryCoach]

Thank you, Farah. I appreciate the kind feedback. Thanks for watching and kindly commenting.

[@jenenre1548]

My favorite respiratory therapist, keep going 👏👏👏👏👏

[@RespiratoryCoach]

Thank you, Jenen. I will!!!

[@mariahc.2681]

This is truly so helpful! I just completed my 3rd term which included my first Vent class and clinical rotation. There are 5 terms total and this next term is going to be the "second part" of vent class and I still feel so lost. THIS is what I needed...someone to break down the BASICS then I can build from there by studying the different abg's, disease processes etc. I feel like a lot of times it gets over- explained too quickly and I need a solid foundation before I can build!. Thank you so much for taking the time to make this video. It has literally helped me SO much and I feel a little more confident now that I actually understand (confidently) the difference between PC and VC and which factors play a role in each! Thank you again!!!! -A tired RT student who wants to make it in this field 😁❤

[@RespiratoryCoach]

Lots of words here, but you're right. Mostly everything is quickly over taught, then expected to critically think through the basic concepts. That's exactly the purpose of this channel. Let me know what questions you have as you move through your curriculum. I'll break them down for you. Thank you for watching and for the kind comment.

[@ellafeng6087]

The best lesson I have ever learnt ! So so so clear and explicit! Thank you so much for your generosity!

[@Kay_2016]

You're a great teacher ! Very simple and on point. Actually, our instructor Dr. Ziyad from Saudi Arabia recommends your channel every year for RT students. Thanks for the good effort !

[@ambereenalam8980]

Superbly explained !!! Excellent way of teaching .

[@RespiratoryCoach]

Glad you liked it! Thanks for watching and kindly commenting!!!

[@faviolagonzalez5118]

your amazing you made it so simple and easy to understand i wish teachers could explain it like you

[@RespiratoryCoach]

Thank you for the kind comment, Fabiola! I appreciate you watching and taking time to comment.

[@omarvierapulido2299]

Thank you very much for your videos, I tell you that with your explanations I learn more than in my clinics. I am trying to see them all because I am very sure that they will help me a lot. Again my congratulations !!!!

[@RespiratoryCoach]

Thank you Omar for your kind comment and for watching!

[@miguelnavarro2092]

Your videos are on point. Thanks for sharing

[@RespiratoryCoach]

Thanks, Miguel. I'm glad you think so. Appreciate the feedback and thank you for watching!

[@xJellaa]

Second video of yours that I'm watching and I just wanna say thanks so much for all your videos! I can already tell that the other videos of yours will be really helpful based on the ones I've watched. I'm taking my 1st mechanical ventilation class this sem and it's tough with all the different modes and info you have to memorize. I'll definitely watch all your videos since I have online exams coming up next week. Thanks again!!

[@RespiratoryCoach]

Hi Anna. Glad you find the videos helpful, and good luck on your mechanical ventilation exam next week. Thanks for watching!

[@authman-alshibly]

Exquisitely explained!

[@Dank0100]

great explanation.. impeccable

[@genaroavaloslopez5550]

gracias por tus videos se me hace mas facil e nterder todo

[@achuith08]

Great explanation my man

[@Dark8982]

Great video. But when to use volume control vs pressure control ?

[@annfillali3820]

Thank you Professor, I was wondering and i know it is too much to ask. I need help with understanding asynchrony ( when the patient fighting the vent) how does it happen and what is the issue?Thanks for everything you do for all the future RTs

[@annfillali3820]

Hi Mr coach, thank you so much 😊 for being able to break down the most most complicated stuff. I was wondering if it is possible to do a video on when patients start fighting the vent ( asynchrony). My professor was not able to deliver the information in a comprehensive. When I watch your videos I get the hang of every piece of information. Thank you for being a great educator 😊😊😊😊🤗Anna

[@drdudirakesh]

Great explanation

[@RespiratoryCoach]

Thank you!!!!! I appreciate the kind comment and you watching.

[@sas5thDr]

Thanks a lot yes it is very basic but it looks to be the most lmportant to understand

[@Makayla8039]

Hi! I’m a RN trying to refresh my memory on some of this in the chance my community hospital gets overrun with covid-19 patients. I was with you all the way up until you were talking about how with pressure control-your pip varies & volume control-your tidal volume varies. In my mind, as your lungs become stiffer & airway is under more pressure with volume settings your tidal volume would have to go up to achieve that set pip & i time. As the same with pressure control as your lungs become stiffer & airway under more pressure your pip would go down because the tidal volume is set and doesn’t automatically adjust itself to compensate for worsening airways. Am I making any sense as to my question? I was following all the way up until you were describing how the varying measurements would react to a patients lungs getting better vs worse. For some reason the varying measurements (pip & tidal volume) would go the opposite direction.

[@RespiratoryCoach]

Hi Makayla! Nice to see a RN drop in and refresh on some respiratory concepts. Referring back to your comment I think I see where your confusion is. I'm going to refer back to your comment to try and clear things up for you. The key words in your comment are as follows, when you stated, "...as your lungs become stiffer...volume settings....tidal volume would have to go up to achieve set pip and I time." Now, think about this Makayla, you started that comment off referring to volume control and ended it talking about pressure control settings. In volume control, we set a tidal volume and pressure will hence vary based on compliance and airway resistance. In other words, compliance and resistance don't change the amount of tidal volume delivered, just the resulting pressure from the delivery of that tidal volume, in volume control. The exact opposite is true for pressure control. You said, "..with pc....lungs become stiff....pip would go down because tidal volume is set...". Remember, in pressure control, the inspiratory pressure is set, not tidal volume. The vent is going to delivery the set insp pressure for the set insp time, and the resulting tidal volume will vary based on compliance and resistance. I thought I might have misspoke during the video, but I went back and watched it and its correct. VC = set tidal volume = varying peak pressures based on compliance and resistance. PC = set insp pressure = varying tidal volumes based on compliance and resistance. Please let me know if this makes more sense now. I deeply desire to help you and others understand these concepts, especially during these times when everyone is being asked to do more with less. Thank you Makayla for watching and commenting! I appreciate you!

[@tomcruise9317]

Sir so its better to use volume control vent as the desire TV is given inthis mode but in pressure control what is the use of increase pip and to atain that pip increasing the I/E ratio when adequate TV is not reaching the alveoli....

[@ericarosales7727]

this was excellent! thank you!

[@lindsaymarie7238]

You should do a video on charging the information from vent onto vent flow sheets for us nurses. I understand the ventilator and I understand what all the numbers mean, but where to document what and where... different story. Especially when we have 1 generic vent flow sheets that are supposed to cover each mode....and each ventilator. As if they are all the same!!!

[@RespiratoryCoach]

Great point, Lindsay! I'll see what I can do!

[@munyrahxz1540]

Hi, i have question i heard if we have pt have metabolic acidosis we don’t do for him extubation, and I don’t understand why? .. also could you be talk about chest protocol when pt have chest trauma what the first setting for him .. and thank very much for reply to me ❤️

[@RespiratoryCoach]

We typically would be cautious extubating a patient with a metabolic acidosis because they will have an increased work of breathing as the respiratory system attempts to compensate for the metabolic acidosis. Doesn't mean we don't ever, just seems like a formula for failure in most cases. Does that make sense?

[@munyrahxz1540]

Yes it make sense, thank very much for your answer ❤️

[@fakhreldinabdelwahid8451]

Good information

[@tomcruise9317]

In which condition we use pressure .volume control vent mode

[@tamalesytortitas]

Maestro!

[@sagarpatel9606]

Can you do a video hfov

[@Suzi_P]

Can you talk about PRVC mode by any chance? Thank you

[@RespiratoryCoach]

Yes mam. I'm working on it. It will be my next video.

[@Suzi_P]

Omg! Thanks so much! i cant wait

[@RespiratoryCoach]

PRVC video is posted. Hope you enjoy and learn! kzbin.info/www/bejne/sJ6yeYRjiL2orrc

[@twinxsaga9857]

Hello respiratory coach. Can I email you?

[@mladenkapopovic1269]

Bravooo🎉

[@vittoria3083]

u r great

[@munyrahxz1540]

I am sorry because I’m asking all time .. 😂❤️. I were discussion with the other RT students about if the pt had Large amount of Secretions and he on pressure control.. Dose the peak will up or just the tidal volume will decrease and thank you ❤️❤️

[@RespiratoryCoach]

In pressure control, excessive secretions will lead to an increased airway resistance, which will result in a decreased delivered tidal volume. Peak pressure is set and will remain unaffected.

[@teaching_paediatrician]

This is a truly wonderful video . The simple language , the concept clearance and basic information that you compiled in a short time is amazing. What is your name sir ? Any instagram account ? Myself a budding neonatalogist in Liverpool

[@erkanbatti]

thank you sir

[@olawaleajiboye9090]

Thank you so much 💖

[@sinclair657]

Thank you

[@edieadjabeng976]

Thank you.

[@munyrahxz1540]

Thank you ❤️

[@RespiratoryCoach]

You are very welcome! Thank you for watching and leaving the kind comment.

[@tailorforeman7082]

Med student here. I came here to try to understand how mechanical vent. alters lung capacities and volumes. Instead, you took my breath away. What formula do I use for that?

[@Makayla8039]

Hi! I’m a RN trying to refresh my memory on some of this in the chance my community hospital gets overrun with covid-19 patients. I was with you all the way up until you were talking about how with volume control-your pip varies & pressure control-your tidal volume varies. In my mind, as your lungs become stiffer & airway is under more pressure with pressure settings your tidal volume would have to go up to achieve that set pip & i time. As the same with volume control as your lungs become stiffer & airway under more pressure your pip would go down because the tidal volume is set and doesn’t automatically adjust itself to compensate for worsening airways. Am I making any sense as to my question? I was following all the way up until you were describing how the varying measurements would react to a patients lungs getting better vs worse. For some reason the varying measurements (pip & tidal volume) would go the opposite direction.

[@RespiratoryCoach]

Hi Makayla, I actually replied to this three days ago. Just came back to see if I had cleared things up for you, but apparently my reply didn't post. So let me try this again. In pressure control we set an inspiratory pressure and an insp time to hold that pressure. Try not to think of it as what tidal volume is needed to achieve that pressure, because the ventilator is not operating in a volume oriented state. It's only focusing on reaching that pressure and holding it. It does this with a variable flow of gas, which is determined by the compliance of the lungs and the airway resistance of the lungs. So when the lungs are very stiff (ARDS), or the ariways are very small (asthma), they don't want to expand as easily as normal lungs do. Therefore, the set insp pressure results in smaller delivered tidal volumes. As opposed to healthy lungs, that would naturally accept more volume with the exact same pressure. In volume control, the exact opposite is true. We tell the vent to deliver a set tidal volume at a set flow rate, and peak insp pressure is dependent on lung compliance and airway resistance. The vent doesn't care about peak pressure in vc, it's only focused on delivering set volume of gas and set rate of delivery (flow). Thus, if you put the same amount of volume in a set of healthy lungs vs noncompliant lungs, the noncompliant lungs will have a higher pressure because they don't want to expand as easily as the healthy lungs. I know I've just repeated what the video said. As I was writing this I may have realized where your hang up is. In your comment you mentioned tidal volume compensating to achieve the set pressure and not compensating in vc. Try thinking about not from a compensating perspective, but rather a resulting perspective. In PC, tidal volume is a result of a set insp pressure and I time, nothing compensates for anything. In VC, peak pressure results from your set tidal volume and flow, and again, nothing compensates for anything. There are modes that do compensate for resulting variables, but PC and VC are not those modes. I admire your desire to brush up on mechanical ventilation during these times. If this concept still doesn't make sense, which is perfectly fine if it doesn't, then please send me an email @ [e-mail]. If you truly desire to understand it, we can set up a time to talk it out over the phone. I can verbally explain this much easier, and 100% guarantee you'll hang up understanding it. Let me know. Thanks for watching, commenting and for all you work at the bedside! Best wishes!