CCP Podcast 029: Mechanical Ventilation...Phases of the Breath

The third in the series with Ollie Poole (@RespReview) on mechanical ventilation. Ollie goes into some more detail on the phases of the breath. This requires some visualisation of the waveform involved. Below is the video from YouTube that Ollie originally produced which should help with that.

Irma Bilgrami does a great job of breaking down some of the principles of mechanical ventilation in her SMACC talk. She approaches it in a similar way to analysing the ECG waveform.

#FOAMed

Delayed Sequence Intubation-

DSI in pts requiring intubation & NOT tolerating preox or peri-intubation procedures http://t.co/vCZX2e10hL #FOAMed pic.twitter.com/3G5MvLiKv7

— Salim R. Rezaie (@srrezaie) February 24, 2015

A new study in Annals of Emergency Medicine seems to support the process of delayed sequence intubation in those patients that will not tolerate pre-oxygneation or peri intubation procedures. EmCrit has a nice algorithm on his site (he was involved in this study) which breaks the process down simply and The Bottom Line has reviewed the paper in question. Scott has also done is usual great job in helping us understand this through his podcast:

Life in the Fast Lane breaks the process down in some more detail.

Cervical Collars-

"CERVICAL COLLARS SLASHED FROM GUIDELINES |" http://t.co/jLcPZVCxca #FOAMed Not just any guidelines - ILCOR guidelines!! This is huge! — UNM Wilderness Med (@UNM_WildMed) February 12, 2015

ILCOR (International Liaison Committee on Resuscitation) have published some draft guidelines on the use of cervical collars which does not recommend their use. Scancrit covers some of this in his blog and, like him, I will quote what they actually say:

"We suggest against spinal motion restriction, defined as the reduction of or limitation of cervical spinal movement, by routine application of a cervical collar or bilateral sandbags (joined with 3-inch-wide cloth tape across the forehead) in comparison to no cervical spine restriction in adults and children with blunt suspected traumatic cervical spinal injury (weak recommendation, very low quality of evidence).
Values and preferences statement: Because of proven adverse effects in studies with injured patients, and evidence concerning a decrease in head movement only comes from studies with cadavers or healthy volunteers, benefits do not outweigh harms, and routine application of cervical collars is not recommended."

Intensive Care Society State of the Art Meeting December 2015

An interesting early steer from @icsmeetings #icssoa2015 consultation. Add your views! http://t.co/nRdSk0a5KN pic.twitter.com/k56pOT6W3a

— GaneshSuntharalingam (@Ganesh_ICM) February 15, 2015

I have had the recent privilege of being introduced to Ganesh Suntharalingam (@Ganesh_ICM) who is involved in the committee with the Intensive Care Society for the State of the Art meeting later this year. He is gathering a team around him who will help make some changes to the format of this excellent conference. He tweeted some results from a survey he published which makes some very interesting reading. What I found exciting is that others feel, like me, that publication of some of the presentations for those not able to attend would be valuable. This is the FOAMed principle in practice. You can continue to add your own views via this link. Advanced Critical Care Practitioner Conference-

3rd National ACCP conference 3rd July hosted by FICM @ RCoA only £40. Save the date !@accpuk @ccpractitioner — CAROLE BOULANGER (@BOULANGERCAROLE) February 16, 2015

Conference details can be found here.