Respiratory Therapist - PEEP and Hemodynamics

Just a fun hypothetical story to share. Hope you learn something.
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[@Kg-nd5ob]

Can you please do more case studies? It's the best way to increase critical thinking skills.

[@RespiratoryCoach]

Working on them now! Thanks for watching and commenting!!

[@robertreadman9518]

Thank you. I have been working as RCP for 7 years now. And always learn watching your videos. Please keep making them

[@nicolasvethencourt7238]

Excellent video. This kind of flash clinical cases are great for understanding the mechanisms behind the decision making

[@RespiratoryCoach]

Thanks for the feedback! Also thanks for watching!

[@ulisesflores935]

Dude you can feel the passion 🙏🏻 thanks for the knowledge g

[@iantru9929]

Been a subscriber since year one of RT school. Just gotten my RRT, love watching your videos to further my knowledge.

[@hypertekptk]

Love these RT pearls

[@jennifertorres4757]

Thank you! These are good reviews and exercises to help us recall and put together what we've learned. I'm a new RT, and I can't help but to feel that I still can't make these clinical connections. So thank you, the information is familiar, just a matter of putting the pieces together.

[@RespiratoryCoach]

It takes time, Jennifer! Stay in the game and keep learning. Thanks for waching and commenting!

[@sergicater9]

The right term describing the right ventricle would be "enlarged" or "dilated", because hypertrophy implies thickened ventricular wall. PE as an acute pressure overload would just dilate. Great video anyway coach!

[@RespiratoryCoach]

Thank you so much for that clarification. I really appreciate that for both mine and any viewer's sake. Thanks for watching and commenting.

[@AhmadSohail-we7zi]

Thanks you for great vidoes. I have been constantly watching your videos and have learned a lot from you. Would make a video on neonatal mechanical ventilation and explain major differences between NICU and ICU mechanical ventilation please?

[@bridgetdoyle5820]

Yea please !

[@plcncar1]

This was an excellent case review. I love how you encourage critical analysis in management of patients. You are a great representative for our profession!

[@RespiratoryCoach]

Thank you so much for watching and kindly commenting!

[@mikeburke6458]

I love this style coach we need more!

[@Dalila-mc7ws]

Briliant ❤

[@rankone7]

This is what we need coach. pathophysiology and management. Thank you with these lectures. peace from Philippines 💪

[@felixgregorian4865]

You are awesome w great attitude Thank you

[@martiniasmith1446]

Your students are very lucky to have you as a teacher

[@lindabackham7937]

Thank you, Joe!

[@roxannelopez7444]

You are my favorite Subscriber so far.

[@sheyz1634]

Thank you so much doc! ❤

[@kaze123ckr]

I read Marion’s ICU book and had a paragraph discussing PEEP on hemodynamics. It claimed in normal heart ( on the steep side of starling curve ) PEEP will cause hemodynamic compromise due to preload dependent. However in Heart in flat side of starling curve, PEEP could actually decreased LV afterload and showed benefits. To your experience, is that true that PEEP maybe helpful in hemodynamics in heart failure patient. (Besides PEEP is good for pulmonary edema )

[@RespiratoryCoach]

To a degree yes, specifically left heart failure, but it still all comes back to preload from my understanding. I'll look into the afterload. Check out this recent video. kzbin.info/www/bejne/qp6tY42lgsx1oNE

[@yasmanygarcia8257]

This was great thank you!

[@xNecropolisx100]

I should be able to log your videos under my continued education hours :P you make me a better RT!

[@juliawithnell2188]

Thank you 👍

[@Saltysteele]

there is NO way PEEP of 10 caused the issue. I sleep with CPAP of 11 to 14 every night! it isn't THAT much pressure. However, despite believing that with 100% of my core, i agree with him- if you made a change and there is any detrimental change in the patient's condition- revert to previous good settings. no questions. even if you know it's not the issue. if there is bad change, change it back to when things were good.

[@RespiratoryCoach]

I agree! Which is why my red flags went up immediately that there was something else causing the problem. 100%

[@jream4ever]

I'm not sure if you do NICU, I've had a patient intubated AC/vc on Dragger. VT 7.4 R 40 . IT 0.38 peep 9. 70%. My question is what would cause the PIP to equal the MAP? pt. PIP most of the shift was basically 9 and desat. When PIP goes to low 20s or mid 20s improved. Pt. Is a 26 wk premie with a 3.0 uncuffed.

[@RespiratoryCoach]

I don't do NICU, so take that into consideration for my answer. Maybe a NICU therapist will see this and chime in. But, it sounds like a positional leak causing the decreased PIP and a loss of alveolar ventilation, thus the denaturation. That's the best I got. I applaud your efforts to seek out understanding of the situation. That's the first sign of a great RT! Thanks for watching and asking your question. Let me know what you find out.

[@scottcochran1848]

According to my training, I thought you should only increase PEEP in increments no greater than 2 cmH2O...

[@juliawithnell2188]

Our protocol has added peep floor --BMI/4. New concept for me, what are your thoughts?

[@unfilterednature7410]

Can you explain the difference between Pmean and Paw., one video about HFOV

[@christorispo]

What would be the expected Abg on this guy with +10/100% vs +5 50%

[@RespiratoryCoach]

The only difference was a pao2 of 500 vs 200.