Want to better understand vent management.

[geekgolightly]

Hi,

I am an RN working in a small MICU (14 beds) and after two years only have a minimal understanding of ventilator settings, and want very much to better understand when to anticipate a doctor ordering Bi-Level vs Inverse ratio vs APRC, etc. I have gone through the LearnICU.org lecture, Mechanical Ventilation-Advanced, but it really seems to just skim the surface. Is there a better multimedia/lecture online somewhere? If not, would you please recommend a book to study.

Thanks in advance!
Kathy

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[Paseo Del Norte]

Hi,

I am an RN working in a small MICU (14 beds) and after two years only have a minimal understanding of ventilator settings, and want very much to better understand when to anticipate a doctor ordering Bi-Level vs Inverse ratio vs APRC, etc. I have gone through the LearnICU.org lecture, Mechanical Ventilation-Advanced, but it really seems to just skim the surface. Is there a better multimedia/lecture online somewhere? If not, would you please recommend a book to study.

Thanks in advance!
Kathy

I would recommend getting with one of the RRT's for one on one ventilator time. A great podcast that covers respiratory topics with regularity is "ICU Rounds" by Dr. Jeff Guy. You can download his podcasts free from iTunes and his website also has links. In fact, he dedicates an entire podcast to BiLevel and APRV ventilation.

APRV and BiLevel can be a hard pill to swallow at first. How well do you understand the concepts of CPAP, BiPAP, PS and PEEP? The first thing to appreciate about APRV and BiLevel is that these modes are spontaneous modes in that you commonly have a spontaneously breathing patient.

Basically, you set two levels of pressure, a high and low level. You spend more time in the high level, then periodically release the pressure to the lower level, then quickly transition back to the high level. However, the patient is not being ventilated with this pressure per se. The patient is spontaneously breathing during all of this. So, it's similar to CPAP in that you have a spontaneously breathing patient with continuous pressure, but that pressure is quickly released periodically.

With these types of ventilation you can hopefully recruit alveoli, prevent derecruitment, decrease WOB and so on. I dare say it may be more comfortable than say inverse I:E ratio ventilation used with a more conventional mode such as AC.

Honestly, many docs have their personal preferences regarding strategies and it is helpful to learn what certain docs prefer and have the resources ready for the specific doc. If your docs are cool, you can also pick their brains.

Hope that helps a little.

 

[deleted6669]

the 2 day "fundamental critical care support" (fccs) course also offers a lot of info on managing vents. it is open to nurses, pa/np, md/do.

 

[geekgolightly]

Paseo, Thanks for the podcast idea, and thoughts. I went to http://burndoc.libsyn.com/ and searched for my topics of interest and found quite a bit. I plan on listening to those.

There is only one doc who does anything other than AC>>IMV>>CPAP>>extubate (or fail and trach/peg). He was a respiratory therapist before becoming a CCM. He likes pressure control ventilation, and used inverse ratio on a few of our flu patients last winter. I just want to understand the indications and patient selection for settings. I would like to work in a university hospital when I move and suspect that those docs will be more adventurous with setting selection.

emedpa, If I see a FCCS course offered in my area, I'll look into pricing. Thanks.

 

[kemper6036]

Paseo, Thanks for the podcast idea, and thoughts. I went to http://burndoc.libsyn.com/ and searched for my topics of interest and found quite a bit. I plan on listening to those.

There is only one doc who does anything other than AC>>IMV>>CPAP>>extubate (or fail and trach/peg). He was a respiratory therapist before becoming a CCM. He likes pressure control ventilation, and used inverse ratio on a few of our flu patients last winter. I just want to understand the indications and patient selection for settings. I would like to work in a university hospital when I move and suspect that those docs will be more adventurous with setting selection.

emedpa, If I see a FCCS course offered in my area, I'll look into pricing. Thanks.

the podcasts are great...probably one of the best free things on itunes. i listen to them at the gym