Mechanical Ventilation - Auto PEEP, Breath Stacking, Air Trapping [Explained Clearly]

[@WhiteboardMedicine]

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[@sinclair657]

Thank you

[@WhiteboardMedicine]

Always our pleasure!

[@randyhoffmann7426]

11:46 Did you misspeak here when you said prolonged *expiratory* times cause breath-stacking or am I missing something? Nonetheless, fantastic video with plenty good info! Sincerely, a Respiratory Therapist that is trying to brush up on Intrinsic PEEP again 😄

[@shevonforbes9826]

Can you do a video on how to fix sensitivity on the ventilator what’s the purpose of sensitive when to identify it n fix it in the vent

[@WhiteboardMedicine]

Absolutely! We will add it to the list!

[@shevonforbes9826]

Can you do more videos on missed trigger, double trigger,

[@WhiteboardMedicine]

Absolutely!

[@guapodesperado2822]

Couple of questions. First, 30 breaths per minutes seems way too much, wouldn't this keep the patient in an extreme state of physical tension. Seems to me longer slower deeper breathing would stimulate healing much better. Such fast breathing would likely increase risk of lung injury and hypertension, would it not? Healthy, calm people don't breathe once every two seconds. 5 to 6 breaths a minute creates far more calm and healing. Slower breathing allows for breathing deeper into the alveoli, while rapid breathing tends to be shallow, with less gas exchange. Second, if this is such a problem, why hasn't someone invented a ventilation device that monitors the air volume in and out and has the ability to help gently draw out any remaining unexhaled air volume prior to the next ventilation input? Seems to me, with modern technology, this should be possible.

[@WhiteboardMedicine]

Great questions! 30 breaths per minute certainly isn't "physiologic" meaning that we don't set the respiratory rate on the ventilator that high unless the patient is so incredibly sick they may die without it. There are some complex reasons that a higher respiratory rate may be indicated for these super super sick patients, mostly though to help them breath off their carbon dioxide to help make the blood less acidic. In the setting of AutoPEEP though, higher respiratory rates actually have the opposite affect! I think that there is a ton of opportunity for technological improvements in this space. I am no engineer so it is outside my area of expertise, but I can't fault you for wondering why we don't have alternate approaches to these problems that extend beyond using a ventilator.