BCRT: British Columbia Respiratory Therapy

Spontaneous breathing is good!?

• A combination of 18-69 hours of diaphragmatic inactivity and controlled mechanical ventilation results in 53-57% reduction of diaphragm muscle fibers!
• Asynchrony and over-assisting contribute to disappearing muscle… so tailor Ti, Insp Rise, and set rates appropriately!

Wake up and Breathe! (ABC trial)

• Paired sedation and ventilator weaning protocol consisting of daily SATs plus SBTs resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved 1-year survival compared with usual care.

The ICU patient remembers…
~20% of ICU patients suffer post-traumatic stress disorder leading to physical & mental health issues.
What they remember? (see Granja article)
1.       Daily needle punctures
2.       Tracheal tube aspiration
3.       Nose tube
4.       Bladder tube
5.       Noise from conversation
6.       Noise from engines and ventilators
7.       Pain
8.       Bedridden
9.       Music in the intensive care unit
10.   Comments from doctors and nurses

Lung Weight (Gattinoni lecture)

• A normal lung weighs 800-1200 grams
• An ARDS lung weighs 2000-4000 grams!  At least 10-15 cm H2O PEEP to overcome the compressive forces in an ARDS lung.

Subclinical Delirium = Brain Failure?!

• Patients suffering subclinical or transient delirium are more likely to have a longer hospital stay, higher mortality rate and require increased assistance at home.
• Current debates about benzos altering the structure of the brain and increasing incidence of delirium
• Should ICUs move to Remifentanil, Propofol, Dexmedetomidine?

Ventilating patients in the Cardiac Surgery Intensive Care Unit is typically straight forward. Moderate tidal volumes with an elevated Fi02, followed by a wean to pressure support ventilation once level of consciousness returns.

Typically this occurs within 4-6 hours upon the patients arrival into the CSICU.
However, there are situations where more aggressive ventilation strategies are required such as increased blood loss from mediastinal chest tubes (?peep), refractory hypoxemia from postoperative pulmonary dysfunction (PPD) (?peep and Fi02, PC ventilation, addition of NO, etc.), ?BP and circulation, etc.

There is a very good article in AMERICAN JOURNAL OF CRITICAL CARE, September 2004, Volume 13, No. 5 which helps explain its occurrence.
Please see tables 1 and 2 in this article for plausible explanations.

Read the full article here.

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