Respiratory Therapy - How does Peak and Plateau Pressure affect Dynamic and Static Compliance?

[@abdigure4190]

I wish I knew your channel when I was taking mechanical ventilation course. Now I’m studying the board exam this video is refreshing for me. We need more RTs like you keep up the good work. I will definitely invite more of my friends to your channel. Thank you!

[@RespiratoryCoach]

Thank you, Abdi, for sharing those kind words. It's never too late, glad you found us when you did. Thanks for watching and spreading the word.

[@KayleeStulz]

Watching this as I study for my Critical Care RN certification, thanks for this information, super helpful!!

[@bairdwill1]

Thank you I am a RRT with 30 years exp. and needed a deep dive into the basics dealing with Covid 19 Pneumonia where we have had to increase our "driving pressures" ie flow, to mediate autopeep. As you know Covid attacks the aveoli. Again, this has helped me immensely!

[@RespiratoryCoach]

Very cool, Will. Love to see veterans on the page to refresh, sharpen up, or just be involved with the future. Thanks for watching and commenting!

[@shaharyarkhan3683]

Thank you so much!! Honestly, it can't be any more simplified than this.

[@elizabethallen9623]

Studying for boards and I have watched you since my first semester. Thanks for all you do!! I also found you on TIk Tok!!

[@RespiratoryCoach]

Awesome, Elizabeth! Thanks for watching and following on TikTok!

[@efrainrivas3703]

Started my Oxygen Therapy module today and came across your video. Thank you so much! This was so helpful!!

[@RespiratoryCoach]

Perfect timing Efrain! Thanks for watching and commenting. Hope the content helps!

[@MelBriannaKek]

Thank you so much for providing all of these videos!! They really break everything down and make things easy to understand. You got me through my mechanical ventilation class!

[@RespiratoryCoach]

That's awesome! Thank you for watching and commenting! I appreciate you.

[@Dr.Jyotsna]

You r way of explaning anything is fabulus.... Makes ventilation like complicayed topic very easy.. As a doctor even i m all the time using ventilator my concept get better with your vedio... Thanks

[@blisseta1089]

Excellent presentation Sir! Thank you very much!

[@SeoDRIFT]

Great video. As a new grad working in field I started to forget some stuff such as this. Keep it up and thank you!

[@RespiratoryCoach]

You're very welcome! Don't let it go man. Hold tight to the intricacies that make you a RRT. Anyone can do our job, but not everyone knows why we do what we do. Only when you display that level of expertise do you set yourself apart from others! Thanks for watching and GO BE GREAT!

[@jane-cy8ix]

All of these videos are great refreshers for information I may have overlooked while learning. I'm taking my CSE next week, so all your videos are super helpful for last min studying!

[@RespiratoryCoach]

Awesome, Jane!!!! Go kick some CSE butt!!!

[@ellimorley1593]

You are literally a lifesaver for us students. Thank you!!

[@ehtishamhaq4097]

wow what an amazing coaching , hatts off sir

[@ICUAdvantage]

Broken down nice and easy! Great job!

[@RespiratoryCoach]

Thanks, Eddie. I appreciate your feedback.

[@stryderhiryu8]

This maybe not having a connection with this Video.. But I would like to ask... When patient is being change.. from one mechanic ventilator tubing to the others... Should the ET tube be clamped during this intervention? Of how many PEEP should there be, before requiring the ET tube clamping when changing? Thank you... I really really love your videos.. so direct ... on point and simplified... 🤗🤗🤗🤗😊😊😊

[@noraramirez3587]

so glad i came across your channel so helpful! thank you for sharing your videos with us!

[@RespiratoryCoach]

You are very welcome. I'm so glad you found us!

[@JacquelineGee]

Bravo Sir👏 Makes total sense

[@RespiratoryCoach]

Love it. Thanks for watching and commenting.

[@leonardomaradiaga7945]

Thanks for the good explanation

[@crislynfernandez2581]

Thank you so much for this! I wish you were teaching the program!

[@fafahotbabe]

Thank you! you made this so easy to understand

[@RespiratoryCoach]

Awesome, glad it made sense and helped you. Thank you for watching!

[@jojomercado19]

Omgosh is it ok to say that I love you lol you are awesome!!! it makes me excited, when you make it easier to understand 👌🏽👌🏽

[@RespiratoryCoach]

You're the best. Thanks for this kind comment. Glad it makes sense and excites you to learn more!

[@LunaBellaAcres]

Honestly thank you so much for these videos. I’m starting from your first videos and working my way up. I originally found your channel trying to refresh my formulas for my boards coming up after I graduate in May. If possible can you make a video about absolute and relative humidity ? No matter how much I read that chapter from anywhere it won’t stick :/

[@RespiratoryCoach]

I'll see what I can do. Thank you for watching the channel. Warning...the lighting in the beginning was TERRIBLE!! Also, good pun. In regards to humidity, it just won't stick. lol

[@ericacarrillo4329]

Hey! Do you have a video of knowing when to place a patient on either VC or PC? (like asthma, pneumonia, ARDS, pulmonary edema, pulmonary hypertension, CHF, and so one) I have my final exam on that in two weeks and have been asking many questions and doing research but I'm justnot understanding? PLZ HELP!!!

[@adzcastiri7911]

Hi coach...nice lecture more knowledge we gained for today. Thanks a lot stay safe coach.

[@RespiratoryCoach]

Hi, Adz. I will man. You do the same!

[@osamamkaeeil2295]

A perfect video.... Thank you

[@decodingcap9965]

Excellent. Well done with the examples Sir.

[@khalidalhazb7012]

Thank you Coach 👍 another great video 👌 Stay safe

[@RespiratoryCoach]

You too, Khalid. Thank you for the kind comment and for watching.

[@tgaskill]

Wonderful explanation!

[@henrythatrtguy6448]

Your videos are great! Big fan!

[@RespiratoryCoach]

Thanks, Henry. I see you have a channel too. Keep up the strong work. I appreciate you!

[@UMBUBA]

Awesome breakdown brother!

[@martiniasmith1446]

I'm starting mechanical ventilation class today, in what order should I watch your mechanical ventilation videos. Need help, teacher is all over the place, trying to stay calm. Thank you

[@kitpesec1536]

So grateful for your work)))

[@RespiratoryCoach]

Thank you, Kit. Grateful for you watching and commenting ❤️.

[@tomcruise9317]

what is a normal platue pressure for us without ventilation what dose it tell ...is it intra alveolar pressure at inspiratory pause or trans pulmonary which is intraalveolar minus intraplural pressure

[@jeckellstallworth]

Hey there Respiratory coach, question...I had a patient who had a PIP of 40 cmh20, the patient was on 10 cmH2o of PEEP with an auto-PEEP of 19 cmh2o...would 9 cmh2o auto-PEEP cause the PIP to go to 40 cmh2o?

[@marialindstrom8486]

Thank you!!!

[@lizl.6874]

How about if we are using pressure support? we will not see the graph.

[@RespiratoryCoach]

Hey, Liz. Typically when discussing the difference between pip and plat we're referring to volume control. In pressure control, they'll be no difference between pip and plat. In pressure support, again pressure is set and typically we aren't able to perform insp holds in spontaneous modes.

[@Happy-yf8bc]

In asthma wont airtrapping lead to reduced lung compliance?

[@mjmjcp83]

Im confused with the increase in PIP, Normal Plat = decrease in Dynamic = decrease RAW the "Problem" column seems to contradict by showing an increase in RAW

[@itsybitsyspider9495]

Wow! 🙏

[@RespiratoryCoach]

I think that's a good thing? Thank you for watching!!!

[@rajivmohan4069]

Woow

[@Ali-pp1ls]

What's the difference between number 1 and number 3

[@RespiratoryCoach]

Number one presents with only an airway resistance problem. Number 3 presents with an airways resistance AND alveolar compliance issue. So number 1 has high peak and normal plat. #3 has high peak and high plateau. Make sense?

[@Gnokhi]

Respiratory Coach... Here's my take... This is what normally happens physiologically (negative pressure ventilation) : Chest wall expands ➡️ Intrapleural Volume increases ➡️ Intrapleural pressure drops further (more negative like a vaccum) ➡️ sucks the adjoining lungs ➡️ (depending on STATIC compliance) ➡️ Intra alveolar volume increases ➡️ Pressure drops (vacuum created) ➡️ (depending on DYNAMIC compliance) ➡️ a particular VOLUME of Air flows (Air gets sucked in) ➡️ Pressure normalised. Note : In both static & dynamic compliance it's the change in pressure that changes the volume. If static compliance is zero (that is the lungs has become like a brick eg Pulmonary fibrosis), the drop in intra pleural pressure, does not increase the intra alveolar volume. In other words, C = ∆V/∆P; ∆P (intra pleural pressures) may be high, but ∆V (expansion of the alveoli) = 0, thus compliance is zero. If dynamic compliance is zero, (eg coin or chicken nugget get stuck in trachea or severe asthma), the drop in intra alveolar pressure (acting like a vaccum) cannot suck any volume of air into alveolus, because the pathway is obstructed. In other words, C = ∆V/∆P; ∆P (intra alveolar pressure) may be high, but ∆V (volume of air sucked in) = 0, thus compliance is zero. In mechanical ventilation , We're injecting some air (quantified by its volume or its pressure just like injecting a drug ! Eg. Injecting rantidine 2 mg [quantified by weight] or 2 ml [qualified by volume] into blood; its both the same provided 1 mg of rantidine is present in 1 ml of solution). This also means that we're using positive pressure ventilation, injecting not sucking (non physiological). Let's assume we're quantifying the injected air by its volume (VC mode). We measure the Elastance (E), not Compliance (C). E = ∆P/∆V ie, Elastance is inversely proportional to compliance (E α 1/C). We can therefore measure compliance INDIRECTLY. WE inject a preset volume & measure the pressure change. The Peak Pressure (PIP) is a measure of both static & dynamic ELASTANCE. For the injected VOLUME of air, if the Peak PRESSURE raises substantially, it means the Elastance (E = ∆P/∆V) is very high & the Compliance therefore is very low. Peak pressure is a SURROGATE that measures the SUM of both STATIC & DYNAMIC compliance. Since, Static Compliance/ Elastance is measured when there is NO air flow, Therefore we make an "INSPIRATORY PAUSE (stop the air flow, making the lung STATIC)", and check the pressure, which is called Plateau pressure (Pplat). A very high Plateau Pressure (Pplat) indicates the STATIC ELASTANCE is very high & therefore the STATIC COMPLIANCE is very LOW ! A high Peak pressure says that the sum of static & dynamic compliance is very low. A NORMAL Plateau pressure states that the static compliance is normal. Thus, a high peak pressure & a normal plateau pressure says that the problem lies with the DYNAMIC COMPLIANCE ie, Airway obstruction! Hope that makes sense... You've said, Dynamic compliance is a measure of Raw & Alveolar compliance, which I think is inaccurate... I may be wrong here..

[@RespiratoryCoach]

Hello , Gnokhi! First, thank you for taking the time to write this very thorough comment. I truly appreciate your time watching and commenting. Thank you so much! I also agree 100%, in volume control, and only in volume control, we should be assessing elastance, rather than compliance. I've been saying this for years now, but the respiratory community insists that we refer to it as compliance, despite the clear conflict of definition. I understand the relationship between elastance and compliance, no need to clarify. "Thus, a high peak pressure & a normal plateau pressure says that the problem lies with the DYNAMIC COMPLIANCE ie, Airway obstruction!" Is this not the exact same as scenario #1 in the video, in which I state the problem is airway resistance? "The Peak Pressure (PIP) is a measure of both static & dynamic ELASTANCE." 100%, which is why I state that peak inspiratory pressure, the variable used to calculate Dynamic Compliance (or Elastance, doesn't matter), is not merely an indicator of airway resistance, but also alveolar compliance. Scenario #2 in the video illustrates this. The only question I have for you is if you have a patient with a decreased dynamic and decreased static compliance, but a normal airway resistance. What's the cause of the decreased dynamic compliance?

[@tomcruise9317]

Last formula cant understand where 10 came from is it any criteria ..... like if the value less then 10 its alveolar problem......exolain sir

[@fishingsouls4christceoofgi614]

T H A N K Y O U

[@rajasekharthottadi5151]

Facing problem in vediostreming 😬😬

[@ozam35]

can you send your e mail

[@RespiratoryCoach]

[e-mail]. You can always find it in the video description also. 😊