Clinical Pearls: Ventilator Modes 101
There are a number of reasons why ventilators are confusing, and I’ll break down how to simplify these factors in this blog post. But the big takeaway is this: just because a patient seems controlled well on the vent does not mean he is; do not leave the task of interpreting the vent and the patient’s response to the vent to others. It is incumbent on you to educate yourself about what the knobs, numbers, and waveforms mean in order to better treat your patient. Let’s talk vent basics and it starts with understanding the mode.
Clinical Pearls: Is It Time To Extubate, An Objective Approach
I spent a lot of years working at the bedside in the ICU. I can tell you one thing a nurse won’t tolerate and that’s an agitated and intubated patient. IYKYK. It’s scary, it’s physically taxing for you, and it’s not good for the patient. So naturally I would immediately call the provider with the “can we extubate” query when they woke up fighting. In my mind they were awake, right? Let’s liberate them from the ventilator!
This is only one scenario in which the clarity I gained in NP school blew my mind at how naive I was as a nurse. Maybe naive isn’t the right word, uninformed perhaps? IDK, I think my point is I didn’t realize there was a systematic approach to assessing extubation readiness. I didn’t properly think through all the reasons why a person would need a vent, nor appreciate all the ways in which a person can fail an extubation attempt. One key factor I learned is that objective medical analysis of the diagnosis and current exam is crucial in predicting risk and then weighing the risk/benefit ratio to determine what is safest for the patient. In this post I’ll walk you through the step by step process of performing this assessment to eliminate as much doubt as possible and set your patient up for success. Skip to the end for a bedside checklist.
Clinical Pearls: Evaluating For Intubation
When is it time to say it’s time? I think back on the really bad days of the pandemic when I walked from room to room asking myself this question repeatedly. Honestly, for intensive care unit level covid that’s what it felt like - a few random meds that typically didn’t help, supportive care, and careful vigilance for when it was time to go on the dreaded vent. Our patients feared it, our families feared it; it was the elephant in the room every time you walked in. Outside of covid pneumonia, there are a million reasons why a patient needs mechanical vent support and failing lungs are just one component. This is a very common question I get asked when I am training a nurse practitioner student Here’s how I approach evaluating a patient for intubation need.
Clinical Pearls: Waveform Capnography
End tidal carbon dioxide (ETCO2) measures exhaled carbon dioxide, it therefore reflects the efficacy with which CO2 is pumped back to the lungs (indirect measurement of cardiac output) and then exhaled (ventilation). Waveform Capnography is a continuous tracing, or waveform, of ETCO2. It is very useful when assessed as a trend.
Clinical Pearls: Pleural Effusions
Pleural effusions can be a big barrier to improving respiratory status in the ICU. Deciding how and when to treat them becomes easier once you break down how to diagnose and treat.