Respiratory Therapy - Spontaneous Breathing Trial and Weaning Parameters

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BEST WISHES!!!

[@patriciapickens9876]

Your videos are great! I have been in RT for 40 years, hospital to DME to sleep and now LTC vents/trachs. So much has changed, new modes, new vents and pretty overwhelming for older therapists. Have learned a lot with your coaching. Keep them coming. Valuable to all of us!

[@lobarita]

ICU nurse studying for CRNA interview. Thank you!!! RTs are experts !!! Love working with y'all.

[@genesispena6336]

Thank you so much we are learning about discontinuing MV now this was super helpful!!!

[@Apratim98]

The way you first give an overall picture and set the stage for more technical details ahead really helps the concepts to get straight into the head..and help us feel as if we are in actual clinical scenario..thank you so mch!!

[@asherweck]

Such a legendary lecture.

[@juanitapeavy9906]

Great material! Thank you for your time

[@ljean1988]

Great and informational video! Thank you for sharing your knowledge and passion!

[@Suzi_P]

Love love love your lectures. ❤️

[@RespiratoryCoach]

Love, love, love that you watch them! Thank you so much for the support.

[@nrendon2009]

Love all your videos! You make it so easy to understand.

[@RespiratoryCoach]

Thank you, Nancy. I appreciate the kind words.

[@sexykays]

On point , you nailed all what we covering for next week exam txu . Sharing this with my classmates

[@ivannasantino3710]

I'm 59 years old and female. I was diagnosed a couple of years ago with COPD and I was beyond scared! My lung function test indicated 49% capacity. After having had flu a year ago, the shortness of breath, coughing and chest pains continued even after being treated with antibiotics. I've been smoking two packs a day for 36 years. Being born without a sternum caused my ribs to be curled in just one inch away from my spine, resulting to underdeveloped lungs. At age 34 I had surgery and it was fixed. Unfortunately my smoking just caused more damage to my already under developed lungs. The problem was having is that I enjoy smoking and don't want to give up! Have tried twice before and nearly went crazy and don't want to go through that again. I saw the fear in my husband and children's eyes when I told them about my condition then they start to find solution on their own to help my condition.I am an 59 now who was diagnose COPD emphysema which I know was from my years of smoking. I started smoking in school when smoking was socially acceptable. I remember when smoking was permitted in hospitals. It was not known then how dangerous cigarettes were for us, and it seemed everybody smoked but i was able to get rid of my COPD lung condition through the help of total cure herbal foundation my husband bought, totalcureherbsfoundation .c om has the right herbal formula to help you get rid and repair any lung conditions and cure you totally with their natural organic herbs,it class products at affordable prices because how awful it is with this lung dictions . I wish anybody who starts smoking at a young age would realize what will eventually happen to their bodies if they continue that vile habit throughout their life, certainly total cure herbs is the formula to get over Chronic Obstructive Pulmonary Disease.

[@repunte93]

I love your videos! Thank you so much. It cleared up a lot of things.

[@RespiratoryCoach]

Cool! That's the objective. Thanks for watching and leaving the kind comment.

[@soraydaalonzo4887]

Thank you Joe, the video is long as you said but kept me engaged until the end because it has many or maybe all the possible elements to check in a weaning trial/evaluation.

[@RespiratoryCoach]

Absolutely! Thanks for watching and commenting, Sorayda!

[@natashamoore4086]

awesome vids as always! very much helpful thank you

[@mihretmichael9700]

It’s a great help Joe thank you 🙏

[@ariettemonestime9296]

Great video. Where were you when I was in school lol. I just discover your channel a month ago. I bench watched most of you video. The way you explain and break thing down is wonderful. I hope you continue making video and blessing us with your knowledge. thank you and you're awesome

[@RespiratoryCoach]

Hello, Ariette! When did you graduate? Thank you for watching and commenting! I will, thank you for the kind comment!

[@traceylomax2156]

I’m lucky enough to have found his videos during RT school.

[@fionashau8300]

Really love ur videos and helps a lot in understading things in the anaesthesia and ifu department....

[@nawafnawaf2538]

You are the best ❤

[@nicholsoucy]

Great video and explanations

[@jjkjjk3558]

Thanks A lot for your passion and very informative videos. Good luck with the channel. Stay safe! Jakub

[@hawasisay264]

Thank you for taking the time to elaborate

[@RespiratoryCoach]

You are very welcome, Hawa. Thank you for taking the time to watch and comment.

[@sherinthomas1091]

Thanks for the video man

[@mommygina33]

This is a fantastic video. Thank you.

[@RespiratoryCoach]

Glad it was helpful! Thank you for watching and commenting!!!

[@F22_Raptors]

All your videos deserve thumb up like button

[@RespiratoryCoach]

Thank you! I appreciate your kind comments and watching!!

[@laurettdiazlopez3515]

Hi and thank you for your wisdom and knowledge! My daughter is home with a tracheostomy tube and on SiMV. What steps do I need to take to begin the weaning process.? She doesn't do well in a facility due to noise which causes her to physically shake. But she is fully aware and coherent. Laurett

[@mlira4947]

Thank you! I like the way you got the RSBI

[@RespiratoryCoach]

Cool!!! Thank you for watching and commenting. It means alot to me.

[@sinclair657]

Thank you

[@chiniemichelle4306]

great video

[@carlamontgomery132]

Thank you! Can you give more info on occlusion measurement?

[@josephsilva8356]

24:10 LMAO!!

[@ventilator98]

When you place a patient on CPAP/PS on a low pressure support, such as a Pressure Support of 5, You're essentially simulating a glorified high flow system. That's essentially what you're doing. You get the FiO2 you want, You're just giving enough pressure to overcome the ETT Resistance, and You're giving them humidification. You essentially have the patient on a glorified high flow therapy system.

[@RespiratoryCoach]

I can agree with that perspective, Peter.

[@ventilator98]

@@RespiratoryCoach I love talking Respiratory. I am glad you agree with the way I put it.

[@petu6inka]

Thank you so much! Stay safe

[@RespiratoryCoach]

You're very welcome! Thank you for watching and kindly commenting.

[@cynthiahe8550]

Great video! What is the reason for minute ventilation decrease in SIMV mode? Many thanks

[@vanessatheurbantarotgoddes2192]

Lawd thank you

[@karenmitchell6654]

Thank you Respiratory coach

[@RespiratoryCoach]

Hi, Karen. You're very welcome! Thanks for continuing to watch and comment. Best wishes!

[@kinder7513]

Present Respiratory Therapist ❤

[@fahimjibran2463]

Thank you Sir for make it Easy

[@RespiratoryCoach]

Thanks for watching and commenting!

[@veronicamontoya2979]

Is the weaning process the same for a tracheostomy tube?

[@greensahuaro2834]

Ventilators ought to show NIPs while pt is breathing. They have gotten stock on flow ventilation, so we can see pt's strength while breathing, improvement or not.

[@RespiratoryCoach]

I don't know about the NIP, but definitely the P100, which is done breath by breath on the G5 (if I'm not mistaken).

[@greensahuaro2834]

Thank you! ...it's good to know the strength of a patient's breath so that way we know if they are getting better or how they are doing! Thanks for your awesome videos!

[@Shaggy2Dopee]

As always, this dude effin NAILED IT! but unfortunately for my school, they want a REAL rsbi... 0/0

[@RespiratoryCoach]

Thanks, Jesse....I think! LOL What do you mean by REAL rsbi? I appreciate you watching!!!

[@karawelch1123]

I love your videos! Wondering if you know of any good practice question resources? Thank you :)

[@RespiratoryCoach]

Thank you, Kara! I appreciate you watching and commenting! There are several practice question resources. I tend to recommend Kettering or Persing Reviews, but there are many other resources. Google "practice respiratory tmc questions."

[@kinder7513]

PRT’s😮

[@staceyevans7602]

Hi Joe! Good morning :) Thank you for your videos! I get so much from them. I had some questions again. How do you get NIF/MIP values? How do you get occlusion pressure values? How do you calculate cuff leak? Also, I thought I had a calculation for VC but now I can't find it. Could you also give me the calculation for VC? Thank you so much!!

[@RespiratoryCoach]

Hi Stacey! Most NIF/MIP measurements can be done using the ventilator in today's world. If not, you would need to use a pressure manometer. Occlusion pressure, because of it's short duration must be done with a ventilator or a pft. To calculate cuff leak...you do the following formula. (Exhaled Vt with cuff up - exhaled Vt with cuff down) / Exhaled Vt with cuff up. This must be done on a controlled breath. This will give you a decimal that you convert to a percentage and a positive cuff leak will give you results greater than 15%. Acceptable VC is 10ml/kg of IBW. So, ask your patient to take in a as deep of breath as possible and exhale completely. Divide that exhaled volume by IBW, and if greater than 10, then your patient possesses an adequate VC. I teach my students the formula, but then tell them that anyone that can generate a VC greater than 1000ml or 1L is good in regards to VC. Think about it, most of your patients are IBW 55-75 Kg. That means acceptable VCs are 550 - 750. A VC greater than 1000 is acceptable for most people. Also, keep in kind the VC is the weaning parameter that requires the most patient cooperation. You're not always able to generate an accurate VC. Hope this helps, and thanks for watching!!!!

[@staceyevans7602]

@@RespiratoryCoach Thank you so much! Very useful as usual!!! :):):)

[@cynthiahe8550]

what is the reason for minute ventilation reduce in SIMV patient?

[@user-ec3db8ul1l]

Coach why some RTs switch to VC mode to evaluate patient for extubation? Is it because of they want to see how much TV gets back after the cuff leak?

[@RespiratoryCoach]

That's exactly why. When evaluating cuff leak you need to control tidal volume to accurately assess return volume. Great question!

[@robertoacastillo]

Great video, thank you very much for sharing all your knowledge and experience! Have you consider joining Clubhouse for live and interactive sessions? I would join!

[@RespiratoryCoach]

That's a great idea, Roberto. I'll look into it. Thanks for watching and commenting.

[@CSEMELEC]

Do you do mechanics before (example AC) or during Spontaneous mode? Such as VC, NIF etc.

[@RespiratoryCoach]

Great question. During spontaneous.

[@michaellaviola3125]

how long does it usually take from the time nurse stops the sedation and when you should start your SBT?

[@RespiratoryCoach]

Great question, Michale. Medication clearance varies per patient, hence SBT timing will vary per patient. Close monitoring of patient activity and drive to breathe is an extremely important element in making this determination. Monitor your patient's RASS and Occlusion Pressure (P0.1) to effectively monitor readiness! Thanks for watching and commenting with your question, Michale!

[@F22_Raptors]

nice videos

[@RespiratoryCoach]

Thank you for watching!

[@Anuthundil]

Great videos. For newborn on SIMV mode why most of the time no spontaneous breathing?

[@RespiratoryCoach]

Hi Anu. I'm not a neo expert, so I don't know for certain, but I would guess the set rate and volume are enough to eliminate the need for spontaneous efforts.

[@msalmankhan8339]

Sir minutes ventilation equal to RR×Vt than RR would be cancelled and spontaneous vt equal to vt

[@ambermartin6436]

Can you explain step by step how to do the cuff leak ?

[@RespiratoryCoach]

100%

[@RespiratoryCoach]

kzbin.info/www/bejne/npzYdmyMZb9jq8k

[@michaellaviola3125]

Im confused on the cuff leak check? How do you give a patient a tidal volume if they are in CPAP/PS mode?

[@RespiratoryCoach]

Great question! You have to switch modes back into a VC mode where you can control tidal volume, or utilize the manual inspiration function that most vents have. Either way you must know the delivered tidal volume to be able to accurately compare to the exhaled volume when you deflate the cuff. Does that help?

[@michaellaviola3125]

@@RespiratoryCoach ok I get it, seems like here in Florida I see alot of PC modes used. Can you do this with PRVC as well. Thanks! I'm a second year student and your vids help a lot!

[@RespiratoryCoach]

@@michaellaviola3125 I'm sure it can be done, but in theory a cuff leak test is comparing exhaled volume to a known tidal volume. PC and PRVC are both pressure modes and thus, in my humble opinion, not a reliable mode to assess cuff leak from. Please let me know if you see otherwise in your clinical practice. Beat wishes as you work through your 2nd year!

[@jmayhane0226]

Is there a daily therapy to help strengthen muscles for someone on ventilator?

[@Shaggy2Dopee]

Cpap

[@jorgegonzalez5249]

Hello Coach! Can you review VC on 10ml/kg?? somewhat confused

[@RespiratoryCoach]

Hi Jorge! I'll see what I can get out!

[@juliedaly2381]

When I started respiratory there was no cpap

[@juliedaly2381]

I want to review the math

[@THEANESTHESIST]

How to calculate NIF?

[@oshannairby7145]

The more negative the better that’s how I remember (NIF)

[@kamangpandeirot3288]

Too many adds

[@p00ks13]

Thank you

[@RespiratoryCoach]

You're welcome, Tony! Thanks for asking and watching. Hope I answered your question.

[@kamaljauoda9633]

Thank you

[@RespiratoryCoach]

You're welcome