Shifting the Work
For a variety of reasons, I’ve been thinking a lot about flow starvation over the past week. This phenomenon is perhaps better named work shifting. (Here’s a nice diagram by my colleague and mentor Eduardo Mireles-Cabodevila which illustrates the key concepts). Ultimately it inspired me to make this brief video as an introduction to the concept. Your feedback is certainly welcome, as I’d like to improve with each successive video.
The Why of Mechanical Ventilation Education
While I always viewed mastery of mechanical ventilation as a key skill for any critical care practitioner, I didn’t enter the field thinking it would be an area of passion for me. As I progressed through training, ARDS became one of my main areas of clinical and research interest, which certainly requires deep understanding of the ventilator. Secondly, it’s an area in which many clinicians, even practicing intensivists, often struggle. The need to democratize high-quality mechanical ventilation education is clear. Groups like the Society of Mechanical Ventilation strive to do so; we’ve attempted to do the same with Critical Care Now!.
The Zen of Ventilation
This topic is certainly enough for its own post, or series of posts. As an introduction, mastery of mechanical ventilation is absolutely a necessity for the zentensivist. Without deep understanding of respiratory mechanics, phases of disease, and what ventilators have to offer, it’s difficult to accomplish several goals:
- Recognize the patient whose dyssynchrony is a sign of impending deterioration
- Know when it’s safe to liberalize vent settings to maximize comfort and reduce need for sedation
- Recognize an underassisted patient who needs a new approach or mode
- Promptly identify patients who are ready to extubate, a.k.a. #AlwaysBeExtubating.
This list is far from exhaustive. What other skills fall under the paradigm of “The Zen of Ventilation”? More on this topic in the future.