Rarely comment on any videos - but this video is absolutely brilliant both in terms of content and delivery. A big bloody thank you (!!) from us medical students.
I'm a UK junior doctor/GP trainee currently working on a respiratory ward. Many thanks for your useful and well explained video. I have always struggled with understanding non-invasive ventilation since medical school, especially some of the ambiguous/interchangeable terminology used. This has really helped me grasp the basic concepts and will hopefully be of clinical use.
Thank you so much in helping me make sense of the concept of CPAP and BiPAP. It helps me as I've just started learning this as a part of my NIV nursing course.
This was a very informative video. My only complaint about it is that it's too quiet. I had my computer's volume all the way up and I could still barely hear you.
Need in detail explanation about BPAP settings about spontaneous inspiration spontaneous expiration,apnea duration and many more like that,, kindly make another video in detail about BPAP ventilatory setting
I have read ( The ICU Book - Paul Marino) that BiPAP delivers several cycles of respiration at two different levels of pressure . So that's the difference between BPAP and BiPAP or both of these are same ?? This is quiet an old video so I am not sure if you will reply...
Wow...just wow...Wish I would have discovered this video earlier in my Pediatric ICU rotation...made the concept of NPPV easier to understand for us medical students. Thank you so much!
Excellent. Very informative. My only question is at the summary of the difference of BPAP & CPAP. The column labeled as "typical setting (cmH2O)" does it correspond to pressure support in CPAP? Because if it corresponds to pressure support, i think will start at 10 or 12 and titrate DOWN so that we can wean the px from mech vent once we hit 6 pressure support. Thank alot.
Hi,I appreciate all of your work&I will encourage my colleagues to follow your job.I want to ask as regard pediatrics if you can include them a little more to your lectures or even give me a source to follow.Thanks a lot.
Mostafa Moheb Thanks for your message. I'm afraid I haven't examined a child since medical school (excluding a plane emergency), so don't feel adequately qualified to be making videos specifically addressing pediatric issues. I don't know of a Med Ed TH-cam channel specifically devoted to pediatrics, however, Paul Bolin has about 75 peds videos on his channel.
Very useful lecture.... Sir, in some book, I have seen that C/I for NIV is 1) Art pH < 7.15, 2) low GCS i.e. less than 8.. is there any hard and fast guideline where to stop NIV and to go for endotracheal intubation and mechanical ventilation?
Hi, this series does help me learn a lot and I really appreciate. But I notice the volume of video 1-5 is really low even though I turn the speaker of my laptop all the way up. This video 6 is much better. I am wondering what is wrong with the audio aspect of the first 5 videos.
hcy5498 I've had a number of people make similar comments about a few of my early videos, including the ones you indicated. I'm not sure what the problem was, since they sounds ok on my computer, and others that I've tried. But in response, I started boosting the volume even louder when making them. Unfortunately, there isn't an obvious way to increase the volume on my end after the fact without recompiling the video and reposting, which loses all the views. A catch 22. But I think you'll find the rest of the series, as well as my later videos, to not have the same volume issues.
i am a biomedical engineering student. i dont understand half the terms dr strong is saying (medical terms). but i understand the concepts and thats all that matters in a medical instrumentation point of view lol
My basic queries:(as per my imagination :P) As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration.... This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
+Yu Hui Tan Thanks! HFOV was part of my original list of topics I had hoped to cover, along with some even less conventional approaches like liquid ventilation and ECMO. But I got distracted by other topics that were frequently requested by viewers, and never came back to it. I still hope to at some point, but can't offer an estimate of when that might be.
+Strong Medicine thank you for your reply:) i hope this topic can be discussed in future about how to manipulate setting in improving oxygenation and ventilation and physiology behind them:) in Malaysia, we don't have RT to handle ventilator and HFOV but nurses are the one to deal with them. Thanks once again:) i refresh my knowledge in adult ICU. Do you cover topics for paediatric with congenital heart defects too?
Yu Hui Tan I find congenital heart disease to be a fascinating topic, but one in which I have virtually no personal clinical experience. Therefore, it's also on the list of topics that I'd like to cover, but will be quite a while until I get to it (i.e. I planning on first exhausting most topics with which I do have significant clinical experience)
+Strong Medicine Yes, they are:) ventilatory management is very tricky and challenging based on each defects especially for patient with single ventricle physiology, MAPCAs and arterial tortuasity syndrome😅
I have a issue with mine. It is set on IVAPS mode. When I let a breath out, it will stop me from taking one in. Today, my heart started acting up. When I switched back to my old bi pap, my heart issues quit. I don't think this lady knows what the hell she is doing. She can't figure out what to do and in the mean time , I'm chancing my life. When I come off of it, I have more trouble breathing. Can you explain? I wear a mask.
I'm very sorry, but I don't have experience using iVAPS mode for my patients. I recommend discussing your concerns with your primary care doctor, sleep medicine doc, or respiratory therapist (whoever is helping you to manage your BiPAP). If you don't feel confident in them, you should seek a second opinion. I'm sorry that I can't offer more specific recommendations.
If you mean why is the volume so low, I honestly don't know. It's sounds only a little lower than normal on my computer, but I've received other similar comments over the years about the earliest videos on this channel. Whatever the problem is, it doesn't seem to affect any videos from after 2013 or so. I know it's not a great solution, but turning on closed captions might help a little.
My basic queries:(as per my imagination :P) As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration.... This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
My basic queries:(as per my imagination :P) As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration.... This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
My basic queries:(as per my imagination :P) As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration.... This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
Rarely comment on any videos - but this video is absolutely brilliant both in terms of content and delivery. A big bloody thank you (!!) from us medical students.
cinosnowy 🙄💤
Have you graduated yet?
I'm a UK junior doctor/GP trainee currently working on a respiratory ward. Many thanks for your useful and well explained video. I have always struggled with understanding non-invasive ventilation since medical school, especially some of the ambiguous/interchangeable terminology used. This has really helped me grasp the basic concepts and will hopefully be of clinical use.
Thank you so much in helping me make sense of the concept of CPAP and BiPAP. It helps me as I've just started learning this as a part of my NIV nursing course.
When my respiratory senior told me to learn about non-invasive ventilation I knew I would be able to find this gem on this channel 🙂
This video is a masterpiece, just as much, if not more so, as the classical music that plays at the end (you are saving lives after all!) Thank you!
Excellent video! Concepts were very clearly explained, the pace was also comfortable.
This was a very informative video. My only complaint about it is that it's too quiet. I had my computer's volume all the way up and I could still barely hear you.
Sorry about the volume - this was one of my first videos, and I was still working out some technical problems.
Great clinician with great explaining ability. thanks a lot!
Very EASY and conceptual explanation..thank you very much
brilliant, concise, thank you, i now understand cpap and bipap. Best vid on the topic!!
Need in detail explanation about BPAP settings about spontaneous inspiration spontaneous expiration,apnea duration and many more like that,, kindly make another video in detail about BPAP ventilatory setting
It is a useful educational video, and I would like to ask you to use mouse indicator while explaining graphs and tables.
Thank you!
I have read ( The ICU Book - Paul Marino) that BiPAP delivers several cycles of respiration at two different levels of pressure . So that's the difference between BPAP and BiPAP or both of these are same ?? This is quiet an old video so I am not sure if you will reply...
Very useful and informative with clear Basic concepts. Sound Volume very Low, need attention
Wow...just wow...Wish I would have discovered this video earlier in my Pediatric ICU rotation...made the concept of NPPV easier to understand for us medical students. Thank you so much!
Thank you Dr Strong .
beautiful lecture on BiPAP
Excellent. Very informative. My only question is at the summary of the difference of BPAP & CPAP. The column labeled as "typical setting (cmH2O)" does it correspond to pressure support in CPAP? Because if it corresponds to pressure support, i think will start at 10 or 12 and titrate DOWN so that we can wean the px from mech vent once we hit 6 pressure support. Thank alot.
Hi,I appreciate all of your work&I will encourage my colleagues to follow your job.I want to ask as regard pediatrics if you can include them a little more to your lectures or even give me a source to follow.Thanks a lot.
Mostafa Moheb Thanks for your message. I'm afraid I haven't examined a child since medical school (excluding a plane emergency), so don't feel adequately qualified to be making videos specifically addressing pediatric issues. I don't know of a Med Ed TH-cam channel specifically devoted to pediatrics, however, Paul Bolin has about 75 peds videos on his channel.
Fabulous lecture. Thank you.
Very useful lecture.... Sir, in some book, I have seen that C/I for NIV is 1) Art pH < 7.15, 2) low GCS i.e. less than 8.. is there any hard and fast guideline where to stop NIV and to go for endotracheal intubation and mechanical ventilation?
THANKS ERIC,IFOUND YOUR LECTURE SERIES PRETTY USEFUL&COMPREHENSIVE.
DR.FALAH AL-JUBOORY.
Well explained. Helps me understand NPPV more.
Hi, this series does help me learn a lot and I really appreciate. But I notice the volume of video 1-5 is really low even though I turn the speaker of my laptop all the way up. This video 6 is much better. I am wondering what is wrong with the audio aspect of the first 5 videos.
hcy5498 I've had a number of people make similar comments about a few of my early videos, including the ones you indicated. I'm not sure what the problem was, since they sounds ok on my computer, and others that I've tried. But in response, I started boosting the volume even louder when making them. Unfortunately, there isn't an obvious way to increase the volume on my end after the fact without recompiling the video and reposting, which loses all the views. A catch 22. But I think you'll find the rest of the series, as well as my later videos, to not have the same volume issues.
i am a biomedical engineering student. i dont understand half the terms dr strong is saying (medical terms). but i understand the concepts and thats all that matters in a medical instrumentation point of view lol
Sir,please provide PDF for this lecture series on mechanical ventilation.?
It was very useful and helpful .thank you
Thank you Doctor Strong. Can this be use in Wuhan virus Pneumonia? ARDS ?
Great job. TY!
can you send for me the link of all lectures of mechanical ventilation
My basic queries:(as per my imagination :P)
As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration....
This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
Thank you for these videos!
Thank you so much !!!!
very well presented and informative thanks!
Sir can you explain the reasons for containdications
m very confused about intermittent positive pressure ventilation and continuous positive pressure ventilation,what is the difference between them
precise and easy to understand video clips :) well done!!can i have topic on HFOV ?
+Yu Hui Tan Thanks! HFOV was part of my original list of topics I had hoped to cover, along with some even less conventional approaches like liquid ventilation and ECMO. But I got distracted by other topics that were frequently requested by viewers, and never came back to it. I still hope to at some point, but can't offer an estimate of when that might be.
+Strong Medicine thank you for your reply:) i hope this topic can be discussed in future about how to manipulate setting in improving oxygenation and ventilation and physiology behind them:) in Malaysia, we don't have RT to handle ventilator and HFOV but nurses are the one to deal with them. Thanks once again:) i refresh my knowledge in adult ICU. Do you cover topics for paediatric with congenital heart defects too?
Yu Hui Tan I find congenital heart disease to be a fascinating topic, but one in which I have virtually no personal clinical experience. Therefore, it's also on the list of topics that I'd like to cover, but will be quite a while until I get to it (i.e. I planning on first exhausting most topics with which I do have significant clinical experience)
+Strong Medicine Yes, they are:) ventilatory management is very tricky and challenging based on each defects especially for patient with single ventricle physiology, MAPCAs and arterial tortuasity syndrome😅
I have a issue with mine. It is set on IVAPS mode. When I let a breath out, it will stop me from taking one in. Today, my heart started acting up. When I switched back to my old bi pap, my heart issues quit. I don't think this lady knows what the hell she is doing. She can't figure out what to do and in the mean time , I'm chancing my life. When I come off of it, I have more trouble breathing. Can you explain? I wear a mask.
I'm very sorry, but I don't have experience using iVAPS mode for my patients. I recommend discussing your concerns with your primary care doctor, sleep medicine doc, or respiratory therapist (whoever is helping you to manage your BiPAP). If you don't feel confident in them, you should seek a second opinion. I'm sorry that I can't offer more specific recommendations.
loved it. thanks
Why the voice is so much low???sadly I can't hear much of these useful contents!
Thank you so much.
From Germany!!!! THANKS!!
Thanks.
Tq
thanks
Cpap graph has been leveled wrongly
Thank you!!!!
Good
Why is it so bloody soft??
If you mean why is the volume so low, I honestly don't know. It's sounds only a little lower than normal on my computer, but I've received other similar comments over the years about the earliest videos on this channel. Whatever the problem is, it doesn't seem to affect any videos from after 2013 or so. I know it's not a great solution, but turning on closed captions might help a little.
can i asck Question
5
My basic queries:(as per my imagination :P)
As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration....
This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
My basic queries:(as per my imagination :P)
As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration....
This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.
My basic queries:(as per my imagination :P)
As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration....
This is my dilemma ... please help me understand better ...
I am not completely sure, but suspect that CPAP and PEEP are required because if you have alveolar edema you will have dilution of surfactants, which are necessary for keeping alveolar walls from collapse. Mechanical force in order to keep increased air pressure inside the alveoli would help in preventing collapse of said walls.