Just wanted you to know I am a preceptor and I have told our new hires about your video series they all like the series I find it very concise and very useful and I will continue to recommend your videos because they are short sweet to the point which is exactly what new hires need and they need something to fill in the gaps between the classroom and the actual workplace so kudos great job!
I definitely learned more with you than with any other tutor or teacher. I needed this from the first day of school. I been out a year and I have to take my boards. Im so nerves. These questions are so confusing. Thank you for the knowledge
I had a student yesterday and gave her your link to check out. Going to make this part of my precepting. You are great. Wish I had you around when I was a student. I will throw out there most of the student I precept understand the ipap vs Epap roles. It’s the adjusting Itime for pt synchrony- which is needed for critical thinking/ keeping pt from intubation. I don’t think their really taught to adjust the Itime when pt’s are tachypneic. I did see your video on Itime vs rise time👍🏼. Hopefully the student link these lessons together and practice them as therapist.
That might be the greatest compliment I could receive. Becoming a part of someone else's precepting. Thank you for the kind comment. Thank you for that and for watching!
Totally agree! I am a preceptor as well and always tell students about your videos. Too many people need to put their egos aside and realize these students will be working in the field one day, and any way to help them (even if it means sending them to a different instructor who can explain things differently) is a positive!
I am a 2nd year and my entire class watches your videos to help get a better understanding of topics. We have told our professors (who is also most of our preceptors) about your channel and they agree that whatever works to help us
I’m starting my second year in august (we are currently doing vents and bipap over summer) and my prof links your videos in our classroom and TELLS us to watch your videos! They are so helpful.
I graduated a few years ago and we were told no TH-cam videos by one of the instructors and then the other wanted to watch it first to approve it. Anyways. I watched your videos and I graduated and I still look through what you have on here
Your videos have helped me so much through school!! I've told my instructors about you and their response is they think it's great we are utilizing other resources to help learn the material. 4 more weeks to graduation! Thank you for all you do!
Hi coach! I appreciate you making all these videos! Quick question. How does the backup rate affect the ventilation? I understand that it's not set to augment tidal volume. But I'd appreciate it if you could please elaborate how the set back up rate work and when you should turn it up or down. Thank you!!!
I shared some of your videos with my professors in school and they love you. They actually use some of your videos as a reference in their lectures..Some even tell us to go and watch your videos especially your PFT breakdown videos
Thanks a lot for your wonderful videos.. is there any difference when we set a pateint ( fully conscious oriented) on BPAP support on ventilator machine (which is usually used for invasive mechanical ventilation) .. is it advantageous since we can set a fio2 of 100 in a ventilator machine and usually not possible in a normal bpap machine..
That's clearly an advantage if you are using a NPPV that can not deliver 100%. Also the need for only one machine and one circuit in the case NPPV is unsuccessful, but in terms of ventilating the patient I'm not aware of any advantages.
Thanks sir for excellent lectures which are concise and conceptual as well. if we can solve both problems of oxygenation and ventilation then whats the role of cpap then ?
Hello Dr. Ali. We don't always have a ventilation problem present. So CPAP plays a role in aiding oxygenation, when no assistance with ventilation is required or desired. Take OSA for example. An inspiratory pressure is not always, even usually, not needed to treat the disorder. During mechanical ventilation, CPAP plays the role of PEEP during our spontaneous breathing patients. Hope this helps. Thank you for watching and kindly commenting!!!
Great explanation! Thank you all the way! If A patient has a metabolic alkalosis with moderate hypoxemia.. do we increase fio2 only or change Epap, Ipap as well? I’m still learning the concept. Thank you
Hello and thanks. No need adjust IPAP in that scenario because there is no present ventilation concern. To address the hypoxemia, it depends on the current FiO2 setting. If you are less than 50-60% then you increase FiO2, if you are already at 50-60% then increase EPAP. Keep asking...keep learning!!! Best wishes!
Another great video! Thank . you. Crazy how just two of your BiPAP videos made 2 many hours of class lecture so much more easy to understand. By the way, love the shirt! Where from?
Thanks Elaine, for the comment. This shirt was given to me from my class of 2019. I'm going to have to replicate it and make it available for others. I get lots of comments on it.
Hi Liz! So, HFNC offers low levels of PEEP as flows increase, and even more so when the patient maintains a closed mouth. It's estimated approximately 1 cmh2o for every 10 lpm over 40 lpm. So a flow of 50 lpm, via HFNC, generates approximately 5 cmh20. Again this is assuming the patient's mouth is closed and the appropriate size nasal prongs are being utilized. Of course, any peep needs greater than low levels (3-5 cmh20), NIV is obviously a better choice. In regards to PS, NIV allows us to adjust IPAP and EPAP levels which regulates PS for the patient. We know that PS augments spontaneous tidal volume, thus directly impacting ventilation. HFNC does not provide any pressure support, but there is evidence that it promotes washing out of anatomical dead-space. So while HFNC doesn't directly increase tidal volume, by washing anatomical dead-space, we can actual improve CO2 clearance by increasing alveolar tidal volume, which also increases alveolar minute ventilation. So, I think you are right in asking how is HFNC "better" than NIV when HFNC seems to be inferior when it comes to PEEP and PS. I don't know if one is always superior, despite my favoritism for HFNC in most scenarios, specifically oxygenation cases. I think where HFNC loses in the measurability of PEEP and PS, it makes up for in patient comfort and tolerance, which leads to better patient compliance. Over the years, I've seen many patients end up being mechanically ventilated, solely because they wouldn't/couldn't tolerate the NIV attempts to avoid MV. I really appreciate you watching and asking these challenging questions. I like this topic and will most likely make a video illustrating these differences between tidal volume and alveolar tidal volume.
Thanks for a great video. I understand we have to go up on EPAP to bring up PO2 and PS to improve ventialtion. But my doubt is 1. What is the optimum Fio2 to start BiPAP with 2. Can we increase FiO2 to improve oxygenation.2. When will one decide that enough, I have to intubate the patient. Can you please clear this. Thanks
Please help me with this question. For example when the epap is eight and the ipap is fifteen, that means that the pressure support is seven. But the Bi Pap machine has a separate button that adjusts the pressure support and the clinician adjusts it to ten. In this case what is the actual pressure support that wy provide to our patient?? (sorry for my pure english, hopefully you understood my question)
We have a case of a NMD / CWD using NIV for the past 12 months on 4/15. Is increasing EPAP above 5 indicated for restrictive disorder, if so what guidelines for the same are available?
Why CPAP doesn't increase TV in non invasive ventilation? It's a pressure along a berthing cycle (inspirium/expirium) . So shouldn't it increase also TV?
It doesn't apply a pressure gradient during the inspiratory phase, thus no increase in spontaneous tidal volume. Make sense? Thanks for watching and commenting!
@@RespiratoryCoach Is it correct to say that during inspiration CPAP applies positive pressure that is able to expend the lungs. But during expiration the patients have to breathe against the same level of pressure. So, it becomes difficult to exhale. Tidal volume cannot improve this way. And if we decide use low level of positive pressure (lets say 5) it's not enough to increase TV. So this is a kind of trap. Using BPAP can solve this problem .
I saw your explanation on Respiratory Therapy - BiPAP vs. CPAP - How to adjust for ABGs?@@RespiratoryCoach Now I understand how CPAP WORKS during inspiration. Thank you.
In general, there's not a "max" ipap setting. What I've found is that bipap works best when the patient is synchronis with the bipap. So yes, an ipap of 25 can remove co2 in a COPD patient. The question is what's your starting pH? 7.15...youre intubating. 7.29...let's give bipap a shot. Hope this helps!
Depending on the situation, yes, 18/8 may be perfect for a particular patient. I was just pulling random numbers to explain the concepts of ipap and epap.
I have a patient with emphysematous lungs on bipap at 20 ipap 10 epap at 80% fio2 maintained but stil patient is hypercapnic at 55 and hypoxemic at 60% . Can i still increase the pressure suppprt more than 10? Thank you
Just wanted you to know I am a preceptor and I have told our new hires about your video series they all like the series I find it very concise and very useful and I will continue to recommend your videos because they are short sweet to the point which is exactly what new hires need and they need something to fill in the gaps between the classroom and the actual workplace so kudos great job!
Awesome! Thank you so much for watching and recommending!
My instructor told us to stay off youtube when seeking more clarification 🙄 but yet here i am listening to you make more sense than my instructor
I definitely learned more with you than with any other tutor or teacher. I needed this from the first day of school. I been out a year and I have to take my boards. Im so nerves. These questions are so confusing. Thank you for the knowledge
I love your videos and truly appreciate them. I’m still watching after passing my boards.
Nice! The learning never stops.
I had a student yesterday and gave her your link to check out. Going to make this part of my precepting. You are great. Wish I had you around when I was a student.
I will throw out there most of the student I precept understand the ipap vs Epap roles. It’s the adjusting Itime for pt synchrony- which is needed for critical thinking/ keeping pt from intubation. I don’t think their really taught to adjust the Itime when pt’s are tachypneic. I did see your video on Itime vs rise time👍🏼. Hopefully the student link these lessons together and practice them as therapist.
That might be the greatest compliment I could receive. Becoming a part of someone else's precepting. Thank you for the kind comment. Thank you for that and for watching!
Totally agree! I am a preceptor as well and always tell students about your videos. Too many people need to put their egos aside and realize these students will be working in the field one day, and any way to help them (even if it means sending them to a different instructor who can explain things differently) is a positive!
I am a 2nd year and my entire class watches your videos to help get a better understanding of topics. We have told our professors (who is also most of our preceptors) about your channel and they agree that whatever works to help us
I’m starting my second year in august (we are currently doing vents and bipap over summer) and my prof links your videos in our classroom and TELLS us to watch your videos! They are so helpful.
Go Be Great! And tell your professors I say HI!
Another great & very easy to understand video on the books!!
I graduated a few years ago and we were told no TH-cam videos by one of the instructors and then the other wanted to watch it first to approve it. Anyways. I watched your videos and I graduated and I still look through what you have on here
Your videos have helped me so much through school!! I've told my instructors about you and their response is they think it's great we are utilizing other resources to help learn the material. 4 more weeks to graduation! Thank you for all you do!
I watch you after every lecture and it helps so much. Thank you!
Thank you very much for this video this has answered a handful of my questions when it pertains to bipap
Sweet! Glad it helped, Derek.
We love your videos our instructors pointed us toward your youtube channel!!
Hi coach! I appreciate you making all these videos! Quick question. How does the backup rate affect the ventilation? I understand that it's not set to augment tidal volume. But I'd appreciate it if you could please elaborate how the set back up rate work and when you should turn it up or down. Thank you!!!
Thank you so much for the breakdown. You should probably come to Ohio and teach my mechanical ventilation class.
I would love too!
I shared some of your videos with my professors in school and they love you. They actually use some of your videos as a reference in their lectures..Some even tell us to go and watch your videos especially your PFT breakdown videos
Great as always very precised and informative vido thank you very much
Thanks for your videos. You explain BiPAP so well.
Could you please explain the back up rate on BiPAP? Is it needed? What does it actually do?
Thanks a lot for your wonderful videos.. is there any difference when we set a pateint ( fully conscious oriented) on BPAP support on ventilator machine (which is usually used for invasive mechanical ventilation) .. is it advantageous since we can set a fio2 of 100 in a ventilator machine and usually not possible in a normal bpap machine..
That's clearly an advantage if you are using a NPPV that can not deliver 100%. Also the need for only one machine and one circuit in the case NPPV is unsuccessful, but in terms of ventilating the patient I'm not aware of any advantages.
Iam a pediatric intensivist in India.love your videos
Much love to India! Thank you for watching!!!
Thanks sir for excellent lectures which are concise and conceptual as well. if we can solve both problems of oxygenation and ventilation then whats the role of cpap then ?
Hello Dr. Ali. We don't always have a ventilation problem present. So CPAP plays a role in aiding oxygenation, when no assistance with ventilation is required or desired. Take OSA for example. An inspiratory pressure is not always, even usually, not needed to treat the disorder. During mechanical ventilation, CPAP plays the role of PEEP during our spontaneous breathing patients. Hope this helps. Thank you for watching and kindly commenting!!!
Great explanation! Thank you all the way! If A patient has a metabolic alkalosis with moderate hypoxemia.. do we increase fio2 only or change Epap, Ipap as well? I’m still learning the concept. Thank you
Hello and thanks. No need adjust IPAP in that scenario because there is no present ventilation concern. To address the hypoxemia, it depends on the current FiO2 setting. If you are less than 50-60% then you increase FiO2, if you are already at 50-60% then increase EPAP. Keep asking...keep learning!!! Best wishes!
Another great video! Thank . you. Crazy how just two of your BiPAP videos made 2 many hours of class lecture so much more easy to understand. By the way, love the shirt! Where from?
Thanks Elaine, for the comment. This shirt was given to me from my class of 2019. I'm going to have to replicate it and make it available for others. I get lots of comments on it.
Respiratory Coach Yes please! I would love it when you do to share with the rest of us! 😀
I feel I learn more from you than from the professors at the university I am paying thousands of dollars too, smh.
Kindly discuss how is HFNC better than Bipap/Cpap NIV regarding PEEP and PS support which I think the former has none? Thanks
Hi Liz! So, HFNC offers low levels of PEEP as flows increase, and even more so when the patient maintains a closed mouth. It's estimated approximately 1 cmh2o for every 10 lpm over 40 lpm. So a flow of 50 lpm, via HFNC, generates approximately 5 cmh20. Again this is assuming the patient's mouth is closed and the appropriate size nasal prongs are being utilized. Of course, any peep needs greater than low levels (3-5 cmh20), NIV is obviously a better choice. In regards to PS, NIV allows us to adjust IPAP and EPAP levels which regulates PS for the patient. We know that PS augments spontaneous tidal volume, thus directly impacting ventilation. HFNC does not provide any pressure support, but there is evidence that it promotes washing out of anatomical dead-space. So while HFNC doesn't directly increase tidal volume, by washing anatomical dead-space, we can actual improve CO2 clearance by increasing alveolar tidal volume, which also increases alveolar minute ventilation. So, I think you are right in asking how is HFNC "better" than NIV when HFNC seems to be inferior when it comes to PEEP and PS. I don't know if one is always superior, despite my favoritism for HFNC in most scenarios, specifically oxygenation cases. I think where HFNC loses in the measurability of PEEP and PS, it makes up for in patient comfort and tolerance, which leads to better patient compliance. Over the years, I've seen many patients end up being mechanically ventilated, solely because they wouldn't/couldn't tolerate the NIV attempts to avoid MV. I really appreciate you watching and asking these challenging questions. I like this topic and will most likely make a video illustrating these differences between tidal volume and alveolar tidal volume.
Thanks for a great video. I understand we have to go up on EPAP to bring up PO2 and PS to improve ventialtion. But my doubt is 1. What is the optimum Fio2 to start BiPAP with 2. Can we increase FiO2 to improve oxygenation.2. When will one decide that enough, I have to intubate the patient. Can you please clear this. Thanks
For sure! Got it in the list.
Here you go!
th-cam.com/video/dUWblkDnDrs/w-d-xo.html
Great educational video..
Please help me with this question. For example when the epap is eight and the ipap is fifteen, that means that the pressure support is seven. But the Bi Pap machine has a separate button that adjusts the pressure support and the clinician adjusts it to ten. In this case what is the actual pressure support that wy provide to our patient?? (sorry for my pure english, hopefully you understood my question)
Learn a lot❤ thanks Joe❤❤
We have a case of a NMD / CWD using NIV for the past 12 months on 4/15. Is increasing EPAP above 5 indicated for restrictive disorder, if so what guidelines for the same are available?
Hi. There's no rule that says you can't go above 5 on the epap with restrictive lung disorders. The question is, why do you want to increase the EPAP?
@@RespiratoryCoach Because there is desaturation below 85% , when on BiPAP in the supine position.
Without BiPAP only on minimum oxygen
@@हपिएम् Great answer. What's the FiO2 on the bipap? That is odd that saturations are worse on the bipap than on NC.
@@RespiratoryCoach Let me send you the Resmed data by email if you don't mind.
@@हपिएम्that's fine. Please ensure that no patient identifiers are included. respiratorycoach@gmail.com
Why CPAP doesn't increase TV in non invasive ventilation? It's a pressure along a berthing cycle (inspirium/expirium) . So shouldn't it increase also TV?
It doesn't apply a pressure gradient during the inspiratory phase, thus no increase in spontaneous tidal volume. Make sense? Thanks for watching and commenting!
@@RespiratoryCoach Is it correct to say that during inspiration CPAP applies positive pressure that is able to expend the lungs. But during expiration the patients have to breathe against the same level of pressure. So, it becomes difficult to exhale. Tidal volume cannot improve this way. And if we decide use low level of positive pressure (lets say 5) it's not enough to increase TV. So this is a kind of trap. Using BPAP can solve this problem .
Maybe i don't understand how CPAP works during inspiratory phase? Thank you. Really appreciate your work.
I saw your explanation on Respiratory Therapy - BiPAP vs. CPAP - How to adjust for ABGs?@@RespiratoryCoach Now I understand how CPAP WORKS during inspiration. Thank you.
What is the maximum IPAP to be given to Px? Can ipap more than 25 can be applied to severe cases of copd? Can it decreased CO2 more than 100
In general, there's not a "max" ipap setting. What I've found is that bipap works best when the patient is synchronis with the bipap. So yes, an ipap of 25 can remove co2 in a COPD patient. The question is what's your starting pH? 7.15...youre intubating. 7.29...let's give bipap a shot. Hope this helps!
Coach I am still confused on how FRC increases in this case? I still havent learned ventilators we are just on non invasive
Thank u sir..
Excuse me sir, how to manage a tachypneic pt with bipap, what is the protocol for tachypneic pt on bipap even if pt Abgs are accepted?
Can we also placed... 18/8 , instead 20/10?
May I know, Why do you choose to place it on 20/10?
Depending on the situation, yes, 18/8 may be perfect for a particular patient. I was just pulling random numbers to explain the concepts of ipap and epap.
Great vedio 💗💗
Great, really helpful
When to discontinue or step down from bipap
I have a patient with emphysematous lungs on bipap at 20 ipap 10 epap at 80% fio2 maintained but stil patient is hypercapnic at 55 and hypoxemic at 60% . Can i still increase the pressure suppprt more than 10? Thank you
Preceptors ❤ Joe!!!
👌👌👌🙏