Precision vent management | Sara Crager at TBS23
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The document outlines an organized clinical problem solving approach to precision ventilator management consisting of the following elements: 1. Identifying the problems to target in multiple body systems including pulmonary, thoracic, hemodynamic, metabolic, and neurologic factors. 2. Determining appropriate strategies and targets to address each problem, such as optimizing PEEP, minute ventilation, and I:E ratio while balancing oxygenation, CO2, pH, lung protection and mental status. 3. Employing an iterative hypothesis testing approach of gathering data, revising hypotheses, and adjusting management on a continuous basis to refine ventilator settings.
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Precision vent management | Sara Crager at TBS23
- 1. PRECISION VENT MANAGEMENT Sara Crager, MD Assistant Professor, Division of Critical Care Department of Anesthesia & Department of Emergency Medicine University of California Los Angeles
- 10. NEW & IMPROVED ALGORITHM?
- 12. Steve Green & David Schriger Annals of Emergency Medicine 2017;70(2):158-160 ~ “…the illusory sense of psychological order provided by a seemingly precise tool”
- 15. WHAT IS THE RIGHT TOOL?
- 17. (The more things that have gone wrong, the more things that will go wrong…) MURPHY’S LAW OF CRITICAL CARE
- 18. YOUR CRITICALLY ILL PATIENT IS A SNOWFLAKE
- 20. MORE ALGORITHMS NOT NECESSARILY THE ANSWER?
- 21. Albert Einstein ~ “Everything should be made as simple as possible, but no simpler”
- 26. :
- 28. Problems
- 29. Targets Problems
- 31. Targets Strategies Problems The things you need to fix
- 32. Framing the right question is sometimes the hardest part
- 34. Targets Strategies Problems The things you need to fix
- 35. Targets Strategies Problems The things you need to fix How you know you’re fixing the problems
- 38. “Measure what is important, don’t make important what you can measure” Robert McNamara ~
- 40. Targets Strategies Problems The things you need to fix How you know you’re fixing the problems
- 41. Targets Strategies Problems The things you need to fix How you know you’re fixing the problems How you go about fixing the problems
- 49. Targets Strategies Problems The things you need to fix How you know you’re fixing the problems
- 50. Targets Strategies Problems The things you need to fix How you know you’re fixing the problems How you go about fixing the problems
- 51. ORGANIZED PROBLEM SOLVING APPROACH TO VENTILATORS
- 54. The lungs do not exist in a vacuum
- 59. The lungs Live inside the Thoracic Cavity
- 65. The Injured brain has trouble with autoregulation
- 68. Ventilators are to lungs as crutches are to ankles
- 72. Too much of a good thing…
- 75. CO2 IS ALL ABOUT THE CLINICAL CONTEXT
- 76. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation CO2 pH
- 82. HOW BADLY DO YOU NEED A MENTAL STATUS?
- 86. You can’t have everything you want All at the same time…
- 88. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation CO2 pH Lung Protection Mental Status PEEP
- 90. PREVENT ATELECTRAUMA WHILE AVOIDING ALVOELAR OVER-DISTENTON
- 91. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation CO2 pH Lung Protection Mental Status PEEP Minute Ventilation
- 92. pH CO2
- 93. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation CO2 pH Lung Protection Mental Status PEEP Minute Ventilation I:E Ratio
- 94. I:E RATIO
- 95. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation CO2 pH Lung Protection Mental Status PEEP Minute Ventilation I:E Ratio V-Q Matching
- 96. V-Q MISMATCH
- 97. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation CO2 pH Lung Protection Mental Status PEEP Minute Ventilation I:E Ratio V-Q Matching Synchrony
- 98. SLEDGEHAMMER APPROACH NOT ROUTINELY REQUIRED
- 103. Targets Strategies Problems Pulmonary Thoracic Hemodynamic Metabolic Neurologic Oxygenation pH CO2 Lung Protection Mental Status PEEP Minute Ventilation I:E Ratio V-Q Matching Synchrony
- 104. The End