You are amazing, I have learnt a lot from you which I cannot find in textbook or even by watching other videos. You are the extraordinary amazing!!!! Now finally I understand pressure support!
Sure, Derrick. Here are a few I've already made. Sorry for the lighting, these were some of my originals. th-cam.com/video/cWnpCBMH4-k/w-d-xo.html - adrenergic vs anticholinergic th-cam.com/video/NS9gRn6FLm4/w-d-xo.html - sympathomimetics th-cam.com/video/sZa20mRon1U/w-d-xo.html - parasympatholytics th-cam.com/video/aI71sHy5cMM/w-d-xo.html - general RT pharm
What is the maximum pressure support for an individual with a given weight.. Like according to disease condition that does not damage the lung.. Or require switching to higher mode?
There is no one stated max as text vary, but in general, most texts agree that if a pressure support of 20-22 cwp isn't working then you should consider changing modes. The idea is to shoot for normal tidal volumes, which we know is 5-8 ml/kg (6-8 during mechanical ventilation).
Thank you for taking the time to make these videos. I was wondering if you could explain if there is a difference between Assist control and Volume control?
Thanks you very much!! You really saved me, to clrearify someting, you mentioned that there is no benifit using PSV when no more rate above the set. Then we only use PSV for patients who take insufficient breaths above the set rate ?
Correct, Yazan. Pressure support does nothing for control breaths. Only spontaneous breaths. No spontaneous breaths = no pressure support. Doesn't mean you can't have it set, just know that it's not doing anything if the patient isn't breathing spontaneously. Thanks for the comment!
Hello again, Waruna. Yes, CPAP and PEEP are the same thing. We refer to it as CPAP when accompanying a pure spontaneous mode of ventilation, and PEEP when in any mode which delivers controlled or assisted breaths. Hope this helps and thanks for watching!
Respiratory Coach when a patient is in Pressure Support Ventilation what do you do next? That a was TMC questions, don't remember the rest of the questions.
@@RespiratoryCoach Respiratory coach can you please do a review on taking the TMC Exam. Your never sure of your ans its always two ans thats the closest. Sometimes you have to choose and ans that doesn't make sense, but thats the best Choice. Thank you!
Thanks for all lectures …. But, I have two questions, the first one : are increase work of breathing and tachypnea considered as indications for PS? And if they are, what is the mechanism of that? The second question if you can break flow decay more and more to allow me to understand it because I don’t understand how it works to end inspiration . ,,,,,,,,,,,, thanks 🙏🙏🙏
Yes, PS can aid a patient with an increased work of breathing and tachypnea. This works by aiding the patient in taking in a larger tidal volume, which reduces work of breathing and requires a lower respiratory rate to establish an affective minute volume.
What about with neonates? I work at a facility where this is grossly misused. Babies are switched from AC\VG to PSV/VG at a rate of 65! No spontaneous efforts from the patient! Truly frustrating 😫😫 so technically still on AC Mode!
That would be frustrating. I have very limited neo/pedi experience so I just have to take your word for it. I wouldn't try to speak on that as it's so far outside my area of expertise. Sorry. I do thank you for watching and commenting though.
Hello again. Fairly rarely! Not to say they don't have a place in patient care, just in my personal experience a patient in an acute situation which is unmanageable with traditional S/T NIV, typically requires mechanical ventilation. Again, this statement is based on personal experiences and should not be taken as reviewed, evidence based practice. On the other hand, a neuromuscular patient, quadriplegic, or failure to wean, trache patient, might benefit from these modes of NIV. That's what I've seen throughout the years. Hope this helps.
@@RespiratoryCoach Yeah thank you! I suppose you're talking about PSV as NIV and not other types of NIPPV...they're as a bridge beetween invasive and spontaneous breathing!
I have a question about setting a ps 5 to overcome airway resistance. Isn't it dependent on tube size and specific features of patient airways? Should we measure plateau pressure to get Raw to set PS for an SBT?
Can I use PSV at the end of general anesthesia when the muscle relaxant partially work and operation end after e. g half an hour to decrease use of relaxant
At 11.45 in SIMV + PS with rate of 40 with set vent rate of 10 As patient breathing over ventialtor you said increases ps to decrease total rate...my doubt is why increases PS why not INCREASE SET RATE
Great question. Increasing set rate would help offset some of the patient's work of breathing, but they still lack the strength to bring in an adequate tidal volume. PS will help them generate larger spont tidal volumes and therefore reduce their spontaneous RR. It was an extreme example and increasing the RR wouldn't be terrible, but the point was in SIMV if the patient is tachypneic with very small tidal volumes, the RT can augment that tidal volume with PS.
Absolutely, all because PC controls the I time. In PSV the patient is in control of their I time, which in some cases may be short and insufficient. In PC, all the patient must do is trigger the breath and the vent does the work from there. In PSV, the patient must trigger the breath and then sustain inhalation for a sufficient tidal volume. Did I answer your question sufficiently? Please let me know if not. Great question by the way!
Thank you! Your videos are helping me so much. Please dont stop teaching us more and more.
Will do!
You are amazing, I have learnt a lot from you which I cannot find in textbook or even by watching other videos. You are the extraordinary amazing!!!! Now finally I understand pressure support!
Brilliant. You explain everything so clearly. Thank you! 😊
Hey, Debs. Thank you for watching and leaving this kind comment.
Thank you! your videos are really helping me fill in the gaps.
Fantastic. Thank you for watching!!!
Thank you...this video helping me out a lot and all your other video keep up the good work !
Thanks for watching and for the kind comment.
You ARE a awesome resource for everyone! Ty
i love you! Thanks for this. I understand PSV better now.
Cool!!!! Thanks for watching and commenting!
Awesome work brother, thanks a lot
your videos are really helpful. Thank you 🙏🏻🤟🏻🙌🏻
Thanks again, Bin! I appreciate the kind comment and you watching.
Thank you man!
Thank you so much for this!!!
Whats the difference of pressure support from PEEP? Im confused
Thank you for all the videos, you teach me a lot. Can you do a video about pharmacology please?
Sure, Derrick. Here are a few I've already made. Sorry for the lighting, these were some of my originals.
th-cam.com/video/cWnpCBMH4-k/w-d-xo.html - adrenergic vs anticholinergic
th-cam.com/video/NS9gRn6FLm4/w-d-xo.html - sympathomimetics
th-cam.com/video/sZa20mRon1U/w-d-xo.html - parasympatholytics
th-cam.com/video/aI71sHy5cMM/w-d-xo.html - general RT pharm
@@RespiratoryCoach Got it! Thank you so much!
This is gold! Thanks so much man, you are awesome. Greetings from Israel☺️😷
Hi! Much love from America!
Great explaination, you are great!! Can you explain pressure support with assured volume ! It would be great please please explain
Hello, Apurva! Got your VAPS on the list and in production. Stay tuned! And thank you, thank you for watching and kindly commenting.
Nice vedio..thanks sir...plz more vedios on ventilator setting for copd ...asthma...etc
....
Done! Let me know what you think, please.
Thank you so much coach..😇
Thank you coach
What is the maximum pressure support for an individual with a given weight.. Like according to disease condition that does not damage the lung.. Or require switching to higher mode?
There is no one stated max as text vary, but in general, most texts agree that if a pressure support of 20-22 cwp isn't working then you should consider changing modes. The idea is to shoot for normal tidal volumes, which we know is 5-8 ml/kg (6-8 during mechanical ventilation).
thank you so much doc
God Bless you Sir! Thank-you so much.
You're very welcome! Thank you so much for watching and commenting!
Thank you for taking the time to make these videos. I was wondering if you could explain if there is a difference between Assist control and Volume control?
Thanks you very much!! You really saved me, to clrearify someting, you mentioned that there is no benifit using PSV when no more rate above the set. Then we only use PSV for patients who take insufficient breaths above the set rate ?
Correct, Yazan. Pressure support does nothing for control breaths. Only spontaneous breaths. No spontaneous breaths = no pressure support. Doesn't mean you can't have it set, just know that it's not doing anything if the patient isn't breathing spontaneously. Thanks for the comment!
Hi. Why do some RT's document I:E, PIP, MAP and MV when patient is on PS or CPAP mode?
Sorry for the late response. I will answer this question for you in a video very soon. Thanks for watching and asking your question.
great explanation sir , thank you for the video lecture sir , sir whats the action of cpap in pressure support , is it simillar to peep ?
Hello again, Waruna. Yes, CPAP and PEEP are the same thing. We refer to it as CPAP when accompanying a pure spontaneous mode of ventilation, and PEEP when in any mode which delivers controlled or assisted breaths. Hope this helps and thanks for watching!
Respiratory Coach when a patient is in Pressure Support Ventilation what do you do next? That a was TMC questions, don't remember the rest of the questions.
Hey Karen! Got this on the list. Will answer ASAP! Thanks for watching and commenting!
@@RespiratoryCoach Thank you so much Respiratory coach.
@@RespiratoryCoach Respiratory coach can you please do a review on taking the TMC Exam. Your never sure of your ans its always two ans thats the closest. Sometimes you have to choose and ans that doesn't make sense, but thats the best Choice. Thank you!
Here you go, Karen! th-cam.com/video/Au6e3t6k0aM/w-d-xo.html
Thanks for all lectures …. But, I have two questions, the first one : are increase work of breathing and tachypnea considered as indications for PS? And if they are, what is the mechanism of that? The second question if you can break flow decay more and more to allow me to understand it because I don’t understand how it works to end inspiration . ,,,,,,,,,,,, thanks 🙏🙏🙏
Yes, PS can aid a patient with an increased work of breathing and tachypnea. This works by aiding the patient in taking in a larger tidal volume, which reduces work of breathing and requires a lower respiratory rate to establish an affective minute volume.
Hey Joe, thank you for your videos. Can you please do a video on how to set up an APRV mode. It’s so confusing. Thank you
Excellent
You’re the best.
What about with neonates? I work at a facility where this is grossly misused. Babies are switched from AC\VG to PSV/VG at a rate of 65! No spontaneous efforts from the patient! Truly frustrating 😫😫 so technically still on AC Mode!
That would be frustrating. I have very limited neo/pedi experience so I just have to take your word for it. I wouldn't try to speak on that as it's so far outside my area of expertise. Sorry. I do thank you for watching and commenting though.
Could you explain when and why you use a controlled or a/c mode (either pressure or volume and why) with non invasive positive ventilation?
Hello again. Fairly rarely! Not to say they don't have a place in patient care, just in my personal experience a patient in an acute situation which is unmanageable with traditional S/T NIV, typically requires mechanical ventilation. Again, this statement is based on personal experiences and should not be taken as reviewed, evidence based practice. On the other hand, a neuromuscular patient, quadriplegic, or failure to wean, trache patient, might benefit from these modes of NIV. That's what I've seen throughout the years. Hope this helps.
@@RespiratoryCoach Yeah thank you! I suppose you're talking about PSV as NIV and not other types of NIPPV...they're as a bridge beetween invasive and spontaneous breathing!
How to troubleshoot patient with high VTe on ac mode? Vte reach to 4000, however patient looking good.
I have a question about setting a ps 5 to overcome airway resistance. Isn't it dependent on tube size and specific features of patient airways? Should we measure plateau pressure to get Raw to set PS for an SBT?
Can I use PSV at the end of general anesthesia when the muscle relaxant partially work and operation end after e. g half an hour to decrease use of relaxant
Is it possible to use CPAP on a trach patient since the upper airway is bypassed
Yes! Just be sure to know your device so that you utilize the correct adapter. This may vary with different cpap devices.
tqqqqq so much my dear brother...
Thank you for watching!!!!
Hi, Joe what state are you in? I am looking for a tutor, I am in the state of Florida.
At 11.45 in SIMV + PS with rate of 40 with set vent rate of 10
As patient breathing over ventialtor you said increases ps to decrease total rate...my doubt is why increases PS
why not INCREASE SET RATE
Great question. Increasing set rate would help offset some of the patient's work of breathing, but they still lack the strength to bring in an adequate tidal volume. PS will help them generate larger spont tidal volumes and therefore reduce their spontaneous RR. It was an extreme example and increasing the RR wouldn't be terrible, but the point was in SIMV if the patient is tachypneic with very small tidal volumes, the RT can augment that tidal volume with PS.
@@RespiratoryCoach thank you coach
@@rajasekharthottadi5151 You're very welcome. Hope it made more sense after the follow up explanation.
If the pt is breathing over the set vent rate on PC, are they being supported more in PC, than switching them over to PS...
Absolutely, all because PC controls the I time. In PSV the patient is in control of their I time, which in some cases may be short and insufficient. In PC, all the patient must do is trigger the breath and the vent does the work from there. In PSV, the patient must trigger the breath and then sustain inhalation for a sufficient tidal volume. Did I answer your question sufficiently? Please let me know if not. Great question by the way!
@@RespiratoryCoach thank you!
@@stevenr672 Thank you for watching and commenting!
👍