Archive for October, 2010

From RadioGraphics:

All of these maneuvers have as a goal reducing the airway pressure and therefore

reducing fistula flow and loss of tidal volume. In addition, the use of selective intubation of the unaffected lung, the use of double-lumen intubation with differential lung ventilation, or the use of independent lung ventilation and patient positioning have been tried.

Download PDF’s

bpfistlBPFistula PDF


The Drinker and Shaw tank-type ventilator of 1929 was one of the first negative-pressure machines widely used for mechanical ventilation. Better known as the iron lung, this metal cylinder completely engulfed the patient up to the neck. A vacuum pump created negative pressure in the chamber, which resulted in expansion of the patient’s chest. This change in chest geometry reduced the intrapulmonary pressure and allowed ambient air to flow into the patient’s lungs. When the vacuum was terminated, the negative pressure applied to the chest dropped to zero, and the elastic recoil of the chest and lungs permitted passive exhalation.


Patient – Ventilator Asynchrony:
Causes, Solutions and New Modes of
Bob Kacmarek PhD, RRT
Massachusetts General Hospital,
Harvard Medical School,

From the CSRT Website a nice overview of the various modes of ventilation.

Pressure targeted ventilation better able to match patient demand than volume … of PeakInspiratory Flow, Usually 25%. Some low flow 5 LPM or. 5% of Peak Flow … Proportional Assist Ventilation. PAV based on the equation of motion

1) KacmarekPAV-NAVA

Wayne Lawson, MS, RRT

Department of Respiratory Care

The University of Texas Health Science Center

at San Antonio

2) New Modes of Mechanical Ventilation handout


840 Quick reference PAV setup



Nice PDF from the U. of Toronto dealing with the abc’s of emergency medicine…… airway, intubation, shock, circulation etc.

Download PDF

When a patient comes in to the ER department, make sure you check the medical alert braclet for the “Difficult Intubation” engraving.

Some people are pro-active and there will not be any surprises if the patient crashes.

Guidelines for Rapid Sequence Intubation (RSI), difficult airways and other information. (From the UK Society of Difficult Airways.


Difficult Airway Link and Guidelines (UK)

Karen J Bosma, MD, FRCPC Critical Care Medicine and Respirology


• PAV(set properly)makes central apneas rare, ensures good patient-ventilator synchrony, may make life easier for the RT, and appears to improve sleep

– Let the patient drive the ventilator

• Controlled mechanical ventilation eliminates central apneas, obviates the need for synchronization, and also appears to improve sleep

Interesting article regarding sleep, synchrony with mechanical ventilation and weaning.


Physiologic Response of Ventilator-dependent Patients with Chronic Obstructive Pulmonary Disease to Proportional Assist Ventilation and Continuous Positive Airway Pressure

The results of this study show that, in ventilator-dependent patients with COPD with difficult weaning, PAV improved minute ventilation and unloaded the inspiratory muscles while CPAP, tailored at a value close to PEEPi,dyn, reduced the patients’ neuromuscular drive and inspiratory effort without significant effects on the breathing pattern. The combination of CPAP and PAV further increased tidal volume and decreased the magnitude of the patients’ inspiratory neuromuscular drive and muscle effort to a level similar to that observed in normal subjects (27, 28).

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