4 years of medical school, 3 years of residency training, 14 years of practice (including Level II Nursery) and this is, BY FAR, the BEST explanation of respiratory physiology I have ever seen or heard. Great review of oxygenation/ventilation, V/Q matching and V/Q mismatch, and how critical lung compliance is to the respiratory process. Outstanding.
@@TalaTalksNICU Well deserved comment. I wish someone would have broken it down so succinctly and easy to understand while I was in residency. The way you explained it is not only simple, but one can attach a visual to it.
Binge watching all your videos on my days off. You're very smart and I love the way you teach! Thanks for working hard and creating these videos for those who work in the neonatal icu!
Trained 32 years back....working with newborns since then...Whenever I feel lost...I go back to basics and trust me no better KINDERGARTEN of Neonatology than TALA talks...Thanks for keeping us updated...
HELLO!!! That's so cool!!! Love the idea of being a kindergarden of medicine- where you learn to read! So cool of you to watch and subscribe- so so happy that these videos are helpful in any way. Also love that - having been out for so long- you still feel like you have stuff to learn. Thank you so much!!
14:06 Thank you so much for your dedication to help others. I’m very grateful for this video. My professor shared your BPD video’s just this past week, which led me to watch this video. I struggle a little in MV. I’m a senior in RT school and I’m doing my first semester clinical at Vanderbilt Children’s Hospital next week. You’re video made it a lot better to understand. Thank you so very much. ❤😇❤
Tiffany thanks so much for writing to us!!! I love that these videos have been used by actual educational programs! Honestly- I think MV in general is one of those things that’s quite hard to understand until your actually at the bedside using ventilators. Then- if you have any sort of background it all sort of clicks into place. We’re trying to set up a video where we go through the different settings on an actual machine- just need to get logistics in place!!! good luck in your role! Hope you love it!!!
My daughter is 1 month old at NICU her ventilator is set at O2 conc. Is 24, Peep 6.0 SMIV rate 45 PC above PEEP 32 and PS above PEEP 6. Please help! I’m not sure but rate is to high I think.
Hi Dr., A much needed topic. I learned a lot. However, can you fix the volumes? I turned the volume way up for when you speak because the sound is so low. When the music comes on, it is jarring. Thanks for making these great videos!
Oh thanks so much for this feedback! It's all a work in process- and we're working hard on improving the logistics! Comments like yours are so helpful though, because we weren't aware of that issue. Sorry about the jarring music but thanks so much for watching and commenting :)
I need to ask a question, is there any strategy to deal with a ventilated baby (who is having PCO2 wash) on low setting and not tolerating CPAP? Thanks
Hi! This is SUCH a good question- I hate it when we feel we’re stuck on the vent too. It’s not good for a baby to have a c02 in the teens or 20s so ideally we’re doing something - there are caveats but for now- we’d like to get that c02 up. So you can try going down to lowest possible vent settings (even PS with a PEEP and no rate). Or try to extubate and place on NIPPV. We’re usually stuck here a lot!!!
@@TalaTalksNICU: For a low PCO2 (Ventilator settings: lowest PIP and Peep with failed extubation) decreasing rate (increasing eT) will cause ⬇️ pCO2, is it right? By the way, what are the lowest settings your unit reach?.
Hi Tala! What a great video. I'm an RN in NICU in New Zealand, starting my orientation on ventilated infants very soon. These videos have helped me prepare tremendously. I was wondering if you have any show notes? The information and the way you explain it makes so much sense to me. Would be great to have a written version too! Thanks :)
Hello Anjeleka- sorry it took a couple of days to answer!! That's so cool you're all the way in New Zealand- another bucket list destination for us! Thank you so much for watching and taking the time to write. Before we film the videos we make up a rough script (and then sometimes I go on diversions!)- but is that the sort of thing you had in mind? I'm (Tala) much more of a reader-learner too- or at least I need to read to reinforce what I heard. Do you have any suggestions of how we could do this? What format? We should probably do some youtube research and figure out what everyone else is doing! ha! Any advice would be greatly appreciated! Thank you again!
Thank you so much for taking the time to reply! I wonder if maybe a PDF cheat sheet with the key points from the video would work? I did go through and watch it again and made some notes as I went. So yeah - perhaps a cheat sheet of the key info?
I understand the PEEP..pip..anda the delta change.but i couldnt understanda the TV change by number.how to calculate when on pressure control vent. Tank you so much.
Another great question! When you're on a pressure control type of vent- you will not necessarily know how much the tidal volume will be affected. The machines would measure it. Obviously, you assume that as you increase the PIP the tidal volume will increase. (Although, as you realize, this depends on the compliance in the lungs and where on the curve the lungs are).
As an ICU Nurse of 5 years with watching multiple videos on how to understand ventilators better, this has been the most helpful video. Thank you for this gift.
Hi! Do you mean endotracheal suctioning generally in the unit? Or when to snd tracheal secretions? Or in the DR (meconium etc.?) Was there something specific you had in mind?? And golden hour is so important- I have a long lecture on it I need to knock down into bite sized pieces!! Thanks so much for your suggestions!
Hello ED- this is a great suggestion- we really need to get back to some respiratory support videos- we lost our way a little! Thanks for the reminder!!
Thank you so much for your simplified explanations! Can you explain 'plateau pressure' please? I see it in the picture you posted in this video to show 'quick guide to lung compliance', thank you!
Hello! Yes- you're right- I didn't cover this enough- and honestly from a clinical standpoint we don't use the term much. But basically- think of the pressure you have to give- as having to overcome two different obstacles to get the lungs to inflate. The first is the resistance (e.g. if you have. really long ETT or lots of secretions), and the second is the actual compliance of the lungs. The plateau pressure refers to just the pressure needed to open up the lungs (i.e. if the resistance were zero- which practically cannot happen). So for example- if you need a PIP of 23 to get a volume of say 4ml/kg of the lungs. If you cut down (a really long ETT) then you'd need maybe a PIP of 22. This decreases the overall pressure needed, but the compliance of the lungs is the same- and so the plateau pressure is the same. make sense??
Hello Shristee! Thanks for the great suggestion- but I don't think I'm enough of an expert to give a lecture on cranial ultrasound imaging- unless it pertains to IVH and post-hemorrhagic hydrocephalus. We did that video on IVH, so maybe take a look at that? Is there something in particular you would like us to cover? Thanks for watching and for commenting!
4 years of medical school, 3 years of residency training, 14 years of practice (including Level II Nursery) and this is, BY FAR, the BEST explanation of respiratory physiology I have ever seen or heard. Great review of oxygenation/ventilation, V/Q matching and V/Q mismatch, and how critical lung compliance is to the respiratory process. Outstanding.
Well wow!!!! Literally going to frame that comment and put it up it made me so happy!!! Thank you soooo much!!!
@@TalaTalksNICU
Well deserved comment. I wish someone would have broken it down so succinctly and easy to understand while I was in residency. The way you explained it is not only simple, but one can attach a visual to it.
Binge watching all your videos on my days off. You're very smart and I love the way you teach! Thanks for working hard and creating these videos for those who work in the neonatal icu!
Thank you Kyle! What a lovely string of compliments! We're so glad you're getting something from these videos. We hope you stay with us!!
Trained 32 years back....working with newborns since then...Whenever I feel lost...I go back to basics and trust me no better KINDERGARTEN of Neonatology than TALA talks...Thanks for keeping us updated...
HELLO!!! That's so cool!!! Love the idea of being a kindergarden of medicine- where you learn to read! So cool of you to watch and subscribe- so so happy that these videos are helpful in any way. Also love that - having been out for so long- you still feel like you have stuff to learn. Thank you so much!!
I love this discussion, omg, but i think i need to go over this or repeat it to fully understand. Thanks so much Doc❤
So glad you find it helpful! Thanks for taking time to write tio us!
14:06 Thank you so much for your dedication to help others. I’m very grateful for this video. My professor shared your BPD video’s just this past week, which led me to watch this video. I struggle a little in MV. I’m a senior in RT school and I’m doing my first semester clinical at Vanderbilt Children’s Hospital next week. You’re video made it a lot better to understand. Thank you so very much. ❤😇❤
Tiffany thanks so much for writing to us!!! I love that these videos have been used by actual educational programs! Honestly- I think MV in general is one of those things that’s quite hard to understand until your actually at the bedside using ventilators. Then- if you have any sort of background it all sort of clicks into place. We’re trying to set up a video where we go through the different settings on an actual machine- just need to get logistics in place!!! good luck in your role! Hope you love it!!!
So grateful to have found this channel! You explain things in such a digestible way. Thank you, from a PICU nurse in London :)
We're so happy you found it too! Thanks Delilah for taking the time to comment :)
My daughter is 1 month old at NICU her ventilator is set at O2 conc. Is 24, Peep 6.0 SMIV rate 45 PC above PEEP 32 and PS above PEEP 6. Please help! I’m not sure but rate is to high I think.
We replied below. good luck.
I'm a fairly new NICU nurse and just oriented to vents. Thank you so much! I watch every video, so I can become a better nurse.
Thank you so much Espoir! We 'hope' you really your time in the NICU :)
Hi Dr.,
A much needed topic. I learned a lot. However, can you fix the volumes? I turned the volume way up for when you speak because the sound is so low. When the music comes on, it is jarring. Thanks for making these great videos!
Oh thanks so much for this feedback! It's all a work in process- and we're working hard on improving the logistics! Comments like yours are so helpful though, because we weren't aware of that issue. Sorry about the jarring music but thanks so much for watching and commenting :)
Well explained... Thank you Madam. Where do you work Madam? I m myself a pediatrician.
Hello! So glad you found it well explained! We are in Texas in the US. I’ve lived in different places so my accent is weird!!!
I may have found a goldmine. Thankyou, algorithm gods.
So happy you found us and it's in any way helpful to you!! Thanks for taking the time to comment :)
You're a god send! Thank you for explaining things that just don't make sense in a textbook
I’m so glad you feel that way! Thank you so much for taking the time to write such a lovely comment!
Hello dr tala and thank you for being generous by sharing such nice and precious videos
Could you plz talk about perinatal asphyxia,
Hi Sara! Yes! Looks like perinatal asphyxia/HIE is gonna be our next topic. Thank you again for watching. We really appreciate you :)
I’m truly loving your channel! Needed something like this. I’m recommending this channel to my friends at work [level 4 NICU]- RN from Texas :)
Thank you so much AB7 for your lovely words! Whereabouts in Texas are you?!!
@@TalaTalksNICU I’m in houston Texas! Children’s memorial hermann hospital
I need to ask a question, is there any strategy to deal with a ventilated baby (who is having PCO2 wash) on low setting and not tolerating CPAP? Thanks
Hi! This is SUCH a good question- I hate it when we feel we’re stuck on the vent too. It’s not good for a baby to have a c02 in the teens or 20s so ideally we’re doing something - there are caveats but for now- we’d like to get that c02 up. So you can try going down to lowest possible vent settings (even PS with a PEEP and no rate). Or try to extubate and place on NIPPV. We’re usually stuck here a lot!!!
@@TalaTalksNICU: For a low PCO2 (Ventilator settings: lowest PIP and Peep with failed extubation) decreasing rate (increasing eT) will cause ⬇️ pCO2, is it right? By the way, what are the lowest settings your unit reach?.
nice, brief, and beneficial..alot of thanks, Dr Tala
So glad you liked it! Thank you so much for taking the time to comment!
You enjoy teaching. Great😊
I do!!!! Thank you!!!!
I wish someone would have explained it to me in your way during residency. But such teachers are rare to find !!!! Absolutely amazing !!!❤❤
What a lovely thing to say- thank you so much!
Hi Tala! What a great video. I'm an RN in NICU in New Zealand, starting my orientation on ventilated infants very soon. These videos have helped me prepare tremendously. I was wondering if you have any show notes? The information and the way you explain it makes so much sense to me. Would be great to have a written version too!
Thanks :)
Hello Anjeleka- sorry it took a couple of days to answer!! That's so cool you're all the way in New Zealand- another bucket list destination for us! Thank you so much for watching and taking the time to write.
Before we film the videos we make up a rough script (and then sometimes I go on diversions!)- but is that the sort of thing you had in mind?
I'm (Tala) much more of a reader-learner too- or at least I need to read to reinforce what I heard. Do you have any suggestions of how we could do this? What format? We should probably do some youtube research and figure out what everyone else is doing! ha!
Any advice would be greatly appreciated! Thank you again!
Thank you so much for taking the time to reply!
I wonder if maybe a PDF cheat sheet with the key points from the video would work? I did go through and watch it again and made some notes as I went. So yeah - perhaps a cheat sheet of the key info?
Thank you!!! We are figuring out how best to do the PDF- with sources etc! Thanks again
I understand the PEEP..pip..anda the delta change.but i couldnt understanda the TV change by number.how to calculate when on pressure control vent.
Tank you so much.
Another great question! When you're on a pressure control type of vent- you will not necessarily know how much the tidal volume will be affected. The machines would measure it. Obviously, you assume that as you increase the PIP the tidal volume will increase. (Although, as you realize, this depends on the compliance in the lungs and where on the curve the lungs are).
Absolutely amazing explanation! Your way of making “complex things simple” is really outstanding!! Thank you very much!!!
Thank you so much Dr. Thalagahage- a lovely lovely comment. So glad you’re watching!
Mam how to set rise time in ventilator?
Oh that is a great question- honestly in neonates this is set up and barely changed (often it's a percentage of the Itime). The RTs set this up!
Your content is well done. Thank you for posting it.
Thanks so much for watching and for the lovely compliment.
Very helpful thank u alot🙏
Fantastic/ thanks so much for being here :)
This is great for teaching my new nurses
Fantastic! So happy it can be of benefit! Thanks for being here!
As an ICU Nurse of 5 years with watching multiple videos on how to understand ventilators better, this has been the most helpful video. Thank you for this gift.
Your comment has made our day! Thank you so much for taking the time to write in! So glad it was helpful :)
Great… Iam a Charge of NICU Iam from Dubai … I recommend all my new nurses to watch your videos . Thanks for your great effort .
Thank you so much Sudha- for watching and for encouraging others! Please let us know if any videos in particular would be helpful? Again- thank you!
@@TalaTalksNICU Sure Dr. Tala
Would like to know the latest in Endotracheal Suctioning in Neonates . And
The Golden Hour in neonates .
@@TalaTalksNICU
Thanks for your prompt response .
Hi! Do you mean endotracheal suctioning generally in the unit? Or when to snd tracheal secretions? Or in the DR (meconium etc.?) Was there something specific you had in mind??
And golden hour is so important- I have a long lecture on it I need to knock down into bite sized pieces!!
Thanks so much for your suggestions!
@@TalaTalksNICU Hi
ET suctioning generally in the unit
Hi. I see more Nava in the NICU. Can you go over NAVA in one of your videos. Thanks
Hello ED- this is a great suggestion- we really need to get back to some respiratory support videos- we lost our way a little! Thanks for the reminder!!
Amazing content, thank you
We really appreciate your positivity! Thanks!
Very concise and easily understandable. Thanks dr Tala
So glad you think so- thanks so much for letting us know :))
Very nicely explained.
Thank you so much for being here!
Thank you so much for your simplified explanations! Can you explain 'plateau pressure' please? I see it in the picture you posted in this video to show 'quick guide to lung compliance', thank you!
Hello! Yes- you're right- I didn't cover this enough- and honestly from a clinical standpoint we don't use the term much. But basically- think of the pressure you have to give- as having to overcome two different obstacles to get the lungs to inflate. The first is the resistance (e.g. if you have. really long ETT or lots of secretions), and the second is the actual compliance of the lungs. The plateau pressure refers to just the pressure needed to open up the lungs (i.e. if the resistance were zero- which practically cannot happen). So for example- if you need a PIP of 23 to get a volume of say 4ml/kg of the lungs. If you cut down (a really long ETT) then you'd need maybe a PIP of 22. This decreases the overall pressure needed, but the compliance of the lungs is the same- and so the plateau pressure is the same. make sense??
@@TalaTalksNICU yes this makes sense, much appreciated for your explanation!!!
Hi Dr Tala thanks for your great effort in simplifying the information Iam NICU doctor👍🏻
Thank you so much Dr. Alhadi! Really appreciate you watching :))
Thank you @drtala
Thank you for being here!
So amazing, so very helpful. Thanks alot
So glad you find this helpful- thanks for letting us know!
Thank you, Dr. Tala. Your explanations are so interesting.
We're so glad you find them interesting. Thanks for writing to us :)
This was FANTASTIC. Thank you!!!!!!
Oh so glad you thought so- thanks so much for taking the time to comment :)
Thank you Doc
Thank you for watching and for taking the time to comment!
You explain so good and made medicine easy , thank you maam
Thank you so much Nasma for watching and for the lovely comment :)
Tala, would you make a video on neonatal cranial ultrasound?
Hello Shristee! Thanks for the great suggestion- but I don't think I'm enough of an expert to give a lecture on cranial ultrasound imaging- unless it pertains to IVH and post-hemorrhagic hydrocephalus. We did that video on IVH, so maybe take a look at that? Is there something in particular you would like us to cover? Thanks for watching and for commenting!
Always doing amazing with these videos!😄
Thank you so much Mari- we really really appreciate all your positive comments :)
.ما شاء الله. بارك اللة فيكم.
Shukran!
Excellent explanation, thanks Tala 👍
Thank you so much Dawn- for watching and for letting us know :)
You are awesome endeed.👏👏👏
Coming from Kevin Durant- that means a lot :) Thank you for watching!
Great teaching style
Thanks so much- for watching and commenting :)
Very nice explanation
Thanks so much for watching and commenting!
Great explanation ❤
Hi Dwara! Thanks so much for watching and for letting us know :)
Thanks
Thank you for watching!
great topic
Thank you Emily! So happy you're still watching :)
@@TalaTalksNICU no. 1 follower here, though am busy am still watching :)
So happy to hear it, Emily. Make sure you make time for yourself too! Medicine is a marathon not a sprint!
Poor recording, not clearly audible and this important topic needs to be recorded in a better and easy audible form
We're sorry! Hopefully one day, we'll get back to this topic with improved equipment!