The Critical Care Triad - The Ventilator Podcast

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In this podcast Caleb, Michael, and Jerome discuss the beginnings of ventilator monitored values. Ventilators now have the options to see so many reported values but which ones should you start to look at and what do they mean? We answer these questions and many more on this episode.

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In this episode we discuss a case scenario of Asthma exacerbation. This can be one of the most challenging patients to manage on the ventilator. If at all possible we try not to intubate these patients, however there are times when this happens. We will discuss clinical treatment, ventilator management, and what our rolls are as transport clinicians in the transport of these patients.
References:
1) National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on September 19, 2018).
2) McFadden ER Jr, Lyons HA. Arterial-blood gas tension in asthma. N Engl J Med. 1968 May 9;278(19):1027-32. doi: 10.1056/NEJM196805092781901. PMID: 5644962.
3) Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. www.ginasthma.org (Accessed on February 13, 2022)
4) National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on September 19, 2018).
5) Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178. doi: 10.1002/14651858.CD002178. PMID: 11279756.
6) Menzies-Gow A, Busse WW, Castro M, Jackson DJ. Prevention and Treatment of Asthma Exacerbations in Adults. J Allergy Clin Immunol Pract. 2021 Jul;9(7):2578-2586. doi: 10.1016/j.jaip.2021.05.016. PMID: 34246434.
7) Nanchal R, Kumar G, Majumdar T, et al. Utilization of mechanical ventilation for asthma exacerbations: analysis of a national database. Respir Care 2014; 59:644.

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In this new ventilator series Caleb, Michael, and Jerome will discuss the different ventilators and their modes. First up, Hamilton T1 APV/(s)CMV. Here we discuss adaptive pressure ventilation and what this means to the patient while is this mode.

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Summary – Part 1 & Part 2

In this episode, we would like to introduce Jesse Carroll, the EMS accounts manager for Hamilton Medical. We discuss ASV (Adaptive Support Ventilation) on the Hamilton T1 ventilator and address misconceptions and myths about the mode. We want to highlight the benefits of ASV in reducing cognitive load for clinicians and promoting lung protective strategies. The limitations and contraindications of ASV are also discussed. This conversation explores the training methods and approaches for ventilator management. The discussion emphasizes the importance of waveform management and understanding pressure, flow, and volume. The dynamic lung graphic is introduced as a valuable tool for identifying disease processes. The conversation highlights the significance of practical training and the use of the dynamic lung in both ASV and conventional ventilation modes. The importance of time on target and the challenges of implementing complex formulas like the Otis and Meads equations are discussed. The conversation concludes with a focus on reducing cognitive load and engaging learners with practical applications.

These episodes (Part 1 & 2) conclude with a focus on educating and building trust in ASV.

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Key Takeaways for Part 1 & Part 2

• ASV on the Hamilton T1 ventilator leverages the power of the proximal flow sensor to measure and manipulate a patient's ventilation status.
• ASV is an advanced monitoring device that reduces cognitive load for clinicians and allows for optimal patient care.
• ASV provides lung protective strategies by monitoring static lung compliance, airway resistance, and expiratory time constant.
• ASV is not a set it and forget it mode, but rather a tool to optimize patient care and engage clinicians in the ventilation process.
• Education and trust-building are essential in promoting the use of ASV and transitioning from ASV to conventional ventilation.
• Understanding waveforms is crucial for effective ventilator training.
• The dynamic lung graphic is a valuable tool for identifying disease processes.
• Practical training and hands-on experience are essential for mastering ventilator management.
• Reducing cognitive load and engaging learners with practical applications can enhance understanding and retention.

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