Respiratory Therapy - Patient-Ventilator Dyssynchrony

[@rt.asmaalshammari]

I would watch your videos all day !! You’re a real teacher !!! many people can explain this to students, but not all of them can make it easy and make sense👍👍👍 Thank you for being in the RT field !!

[@RespiratoryCoach]

That's a very nice comment! Thank you for watching and for commenting!

[@traceylomax2156]

As a working RT new grad I still refer to his videos.

[@indiabellerin2586]

It's the combination of how you explain things and that you recorded it for free ❤thank you for all you do

[@joannpeterson3597]

I am really enjoying your teaching. Thank you

[@RespiratoryCoach]

Nice! Thanks for watching and kindly commenting!

[@eduardonava1291]

Hi coach, after watching countless hours of your awesome videos, I am finally checking in with you as your virtual student. A little bit about me, I am a second year RT student on my second rotation in one of the biggest hospitals in the Los Angeles area. I consider myself to be a dedicated student and feel fortunate enough to have bumped into your videos. Because of that I have been able to be competent in clinic as well as in the classroom. Thank you.
I write to you in this particular video because I was just watching it for the first time yesterday morning, right before clinic. For that reason, I wasn't able to fully grasp the theory of the video (usually watch them 3 times before I fully understand).
Anyways, I was placed in the ER and was fortunate enough to be part of 5 intubations/transports. A particular case caught my attention for a few reasons. Not disclosing any personal Pt info for obvious reasons but she was a 63 year old F with cancer/PNA and was intubated for severe hypoxia.....Pt was intubated placed on the vent but the doctors where concerned that she was not doing well because of the high peak pressures 36-42, low sats 88-89 at 40% fio2, and dysynchrony with the vent (AC/VC). My RT was asked to do something about it but he maintained his position explaining to them that she was "bucking the vent" because she was waking up and if they wanted her to synchronize with the vent then to increase sedation and so they did. This was in a time frame of 30 min after being ventilated.
As soon as he said it raised flags in my head because you always emphasize in having the "vent breathe like the patient and not the other way around"..... I take that to heart.
So my light switch came on and I went to see the waveforms (my weakest point) to see if the pt had any abnormalities like the ones mentioned in this video and boom, she did! Unfortunately for me, I could not remember the differences you mentioned but they looked like a variety of all the examples you provided.
My question to you, even with all the omitted data, is in that acute situation do we do what was done or B try to fix the breathing with the aid of the waveforms?
If you got this far I appreciate it and thank you, God bless.

[@RespiratoryCoach]

Hello Eduardo! I've noted the scenario you presented and will post a response soon. Thanks for watching, for commenting and especially for officially checking in!

[@tpax9758]

God dog, I am amused with how much finesse you possess when it comes to teaching mechanical ventilation. In regards to teaching-either you got it or you don't- you got it!

[@RespiratoryCoach]

Maybe the nicest comment ever. Thank you! I try!

[@ariannao6441]

This was amazing. I am an icu nurse on a COVID unit. And everyone is ventilated. This was so helpful.

[@RespiratoryCoach]

Awesome, Arianna! Glad it was helpful!

[@vangilovesdaddy]

Wow you have gift of explanation! I started with one video post now I cant stop watching, thank you for all your time and patience with are questions

[@latestlatest4760]

Can you also make a video about dysynchrony for Pressure Control mode too? Thanks

[@bryanpereyra5258]

I TOTALLY understand the way you break down things Respiratory Coach! You are awesome! I was out of the field (not working as an RT) for some time but with your help, it has been a good transition back in. Thank you for that! May I ask how to obtain a shirt just like the one you are wearing in this video, please? Much appreciated! Thank you for all that you do! You are a blessing!

[@RespiratoryCoach]

Hi Bryan! Welcome back to the world of RT. Glad you find the channel helpful. That particular shirt is not my design, at least, not yet. I have another design in production that I will be sharing with the channel in the coming weeks. Stay tuned and thanks for watching!

[@osamaqazi5301]

Finally someone makes sense.... Thank you coach. I wish i had found you earlier on youtube

[@ThriveOnWheels]

i am on mechanical ventilator as a C2 incomplete quadriplegia/ for the longest time I was managing on my own with sniffle quick inhale of diaphragm expansion (nearly not moving) and slow down my entire body to just for my respiratory rate to be normal. but now I got on the Vent mouthpiece during the day. I feel like I need it all the time. everytime I am off for a min, I went back on, it's PIF is 120-130...then it would drop down into 80's . I am always air hungry when I am out and about without the vent. But also weirdly things you were talking about for the dyssyncony... I get high respiratory rate in the early morning upon waking up every 4-5 min for like an entire hour... and my watch still showed low SpO2 stats... I was seriously not getting any pressurized air until the alarm sets in. and giving me a bigger breath in...

[@RespiratoryCoach]

Be sure to contact your PCP for questions and concerns related to the appropriateness of your home ventilator settings.

[@morganjones677]

You teach me soo much more than the book. Thank you!

[@RespiratoryCoach]

Yet, it's all from the book. Thank you for this kind comment. I appreciate you!

[@bridgettpoints5901]

Thanks for always being informative! Love your videos.

[@RespiratoryCoach]

Thanks, Bridgett. I appreciate the kind comment.

[@Pranj10]

Thankyou so much from a MD.

[@Dollfacenowaist]

84% on my test! thank you!!

[@tiffanidazzo9468]

I have a patient at my sub acute who had an anoxic brain injury and is on the vent. She has multiple grand mal seizures a day if she is not giving her medications right on time. She starts to seize, her flow demand increases and the ventilator starts to block her exhalations. We use a trilogy ventilator where we can only adjust the I time, causing disynchrony if I'm not close by to watch and adjust.

[@RespiratoryCoach]

We need to zoom. You have lots of questions that I would love to help you answer. Send me an email... [e-mail].

[@javondashoffner-collins540]

Thank you! This made so much sense!

[@joannpeterson3597]

"I like a flow of 60" 😅 I can imagine your face lol

[@maxpla168]

Great material Joe

[@RespiratoryCoach]

Thanks Max!

[@Belindasilva]

I wish you could come take care of my fiancé. I’m sitting here watching breath-stacking on him for days now. What you just described is what I’m have been seeing and my concern has lead me to look for a video on it.

[@user-yk8cg8cz9w]

❤

[@nigel5009]

If you have a ventilator that doesn't allow you to directly change the flow, how would you adjust the flow? For example, servo U and I don't have a flow adjust function.

[@RespiratoryCoach]

Hi, Nigel. Then you have to adjust I time. You have to be able to control either flow or I time. Decreasing I time will increase flow. Likewise, increasing I time will decrease flow. Hope that makes sense. Thanks for watching and commenting!

[@m.khadeer7014]

excellent !!!

[@sinclair657]

Thank you ⚫🟢🟡

[@NafeesAhmad-go8og]

Thanks a lot dear

[@kamaljauoda9633]

Thank you

[@bugynites09]

See this a lot with patients on ECMO but that’s a different issue somewhat.

[@RespiratoryCoach]

Interesting! Would be curious to the impacts of reducing P-V asynchrony during ECMO. Thanks for sharing and watching!!!

[@farhanqadeer82]

I appreciate you making this video. Will like to know whenever you can teach how to wean off patient from pressure control. Also waveform in more detail if you can. Again thanks a lot

[@RespiratoryCoach]

Got it on the list. Will answer asap. In the meantime check out my other waveform videos. th-cam.com/video/491udmy7K1E/w-d-xo.html

[@RespiratoryCoach]

th-cam.com/video/kcnJZE--Vwg/w-d-xo.html

[@CSEMELEC]

So then what would we do in APV-CMV mode (aka PRVC) to fix the breathe stacking? What if you have increased the VT from 400 to 500 and they are still sticking? Keep going up?

[@ginettepatrick5860]

Why not try pressure control or pressure support at that matter so they can control their own flow?

[@tl854393]

Thank you, but How about Vte of patient with flow of 135l/min?

[@moh.alshamierisrael863]

thanks coach👍👍 been watching all your videos and it help me so much👍
just want to ask questions,
Is it Okay to increase the flow that much just to correct the flow hunger of the pt.?
and are there any complications for that amount of flow? 140lpm?

[@jeannemori1320]

How did increasing the flow affect expiratory/air trapping? thank you

[@johnmayor48]

for the second dysynchrony if the pt is on a pressure control mode how would we fix this since the flow varies with each breath

[@anjishnujitbandyopadhyay787]

Hi RC, awesome video !! Could flow desynchrony occur on PRVC mode

[@RespiratoryCoach]

Yes, absolutely! This actually causes a sneaky situation. Your patient is flow hungry, so their diaphragm is dropping faster than the variable flow from the vent. This decreases intrathoracic pressure, which increases compliance and will lead to a larger delivered tidal volume. In PRVC, the vent now makes an adjustment in response to the increased tidal volume (assuming it's greater than the target Vt) and actually decreases insp pressure, which in turns decreases insp flow. Remember the patient is flow hungry, and the vent is now decreasing delivered support and flow. Have you ever seen this?

[@anjishnujitbandyopadhyay787]

I haven’t actually seen this , I just asked out of curiousity!! PRVC is supposed to match the patients flow right??

[@RespiratoryCoach]

@@anjishnujitbandyopadhyay787 Not really, PRVC is essentially just self adjusting PC. Flow in PC is variable dependent upon compliance and resistance to achieve and sustain insp pressure for the set I time. Now, patient's insp flow will change compliance therefore changing insp flow, but it's not an attempt to match the patient’s flow. Make sense?

[@dtmfool789]

Why would that RT you did hand off with change it?! Couldn’t you get the physician write specific orders?

[@RespiratoryCoach]

You would think so, Daniel. Average Is Easy...Don't Be It!

[@ashleythompson6278]

With the flow hungry patients, could they be switched to a demand flow mode? (Idk specifically for this patient, but could it be an option?)

[@RespiratoryCoach]

Absolutely! Whatever meets that patient's insp flow demand will be better than not. Fantastic recognition of a great option, Ashley.

[@ua6440]

Super

[@RespiratoryCoach]

Probably the best one word comment ever! I think you're super! Thank you!

[@ua6440]

I just found your videos and as RRT I truly appreciate the clarity and depth of understanding.
I will definitely keep watching your videos to sharpen my skills
Thanks again

[@RespiratoryCoach]

@@ua6440 That's awesome. Love to see licensed RRTs possess the desire to sharpen their skills. Go Be Great!

[@heartyshor]

Hey! Anesthesia intern here :) Been watching your vids for some days and they are amazing. Old video, but I dare to ask you a question. Are these statements true: In volume control flow is fixed with each breath and in pressure control, flow is variable depending on trigger (patient triggered breaths have variable flow up to ventilator maximum depending on their inspiratory effort and time triggered breaths have fixed flow by rise time? Hope my question makes sense and i don t look stupid asking :)) Keep up the videos and thank you for them!

[@RespiratoryCoach]

Hi Adrian. Definitely your volume control statement is true. In regards to PC, all breaths have a variable flow to reach and sustain the set insp pressure for the set I time. Flow is variable based on compliance and resistance. Less compliant lungs require less flow to reach the insp pressure, while more compliant lungs require higher flows to reach the insp pressure. Rise time will only affect how fast the insp pressure is reached, but not affect I time. You 100% don't look stupid. Don't ever worry about that on this channel. I hope I provided you with clarity on this subject. If not, let me know and I'll try again.

[@heartyshor]

@@RespiratoryCoach Thank you for your answer! If i understand right, rise time that has nothing to do with flow? (lower rise time=higher flow and vice versa).

[@mxa9063]

The RT always tells me it's because I need to sedate more.

[@RespiratoryCoach]

And that may be true in some circumstances, but not always. Imagine being on a vent and not being able to breathe the way you want to because the vent settings are different than your desired breathing pattern. Here's the process...patient-vent asynchrony = more sedation = longer time on vent = longer stay in ICU = increased risk for mortality. As you know, the easiest way to settle a vented patient is more sedation, but that's clearer not always the best option, and rarely the only option. Thanks for the comment and for watching!

[@safazohaib7795]

Didnt learn IPPB in school, dont use it in practice

[@MscRespiratoryTherapy]

If we increase flow rate that much doesn't it affect the inspiratory time

[@RespiratoryCoach]

Absolutely! Increase flow = decrease I time

[@Niko_ocho]

@@RespiratoryCoach what was your iTime with the patients flow so high?

[@iantru9929]

I hate how other therapists just override what u did even tho u show them proof and data to back it up.

[@is1283]

He looks drunk or hungover

[@RespiratoryCoach]

LOL...awesome comment and not the first time I've heard that. Thank you for watching and commenting!!!

[@starstarling2932]

Either way he still speaking facts!!😂😂

[@user-yk8cg8cz9w]

❤