Earlier this month I had the incredibly opportunity to attend a conference for Respiratory Therapy students held by The Medical University of South Carolina (SCSRC Donna Harvey Student Forum).
The conference included several discussions and interactive workshops on various topics such as noninvasive ventilation, high frequency jet ventilation, cardiac defects, hemodynamics, and waveforms- just to name a few.
My favorite part of the conference was the lung protective workshop. For me this was the biggest take- away from the conference and a real eye opening experience that I just have to share! We were able to see several demonstrations of various types of ventilators (Servo, HFJV, HFOV) connected to preserved pig lungs. Compared to the human lung, pig lungs have an extra lobe called an 'accessory lobe' and have a larger surface area than a typical human lung, however; the alveoli (where gas exchange takes place) in pig lungs are smaller than a human therefore, requiring a smaller amount of volume of approximately 3ml/kg. Seeing how the lungs reacted to different levels of tidal volume and PEEP (positive end expiratory pressure) was incredible to say the least! It made me really think about how I am affecting a patient's lungs when I am making changes on the ventilator.
A major take away from these demonstrations was- VOLUME KILLS. We saw how adding too much tidal volume to a lung can cause overinflation resulting in blebs which ultimately can lead to a pneumothorax. Evident from the demonstrations, a patient will most often benefit more by determining their optimal PEEP. To determine optimal PEEP you want to titrate the PEEP up slowly and look for improvement in lung compliance. PEEP is used to improve oxygenation in patients with refractory hypoxemia. In addition, PEEP opens collapsed alveoli, thereby restoring the FRC, and decreasing physiologic shunting. Lung protective strategies implements low tidal volumes and higher PEEP. Patients with acute respiratory distress syndrome (ARDS) benefit from lung protective strategies by reducing hyperinflation and keeping the lungs open when possible. When using lung protective strategies you want to keep the patients plateau pressure <30mmHG. Assessing your patient and knowing when to implement lung protective strategies can be vital to delivering life-saving care.
The conference included several discussions and interactive workshops on various topics such as noninvasive ventilation, high frequency jet ventilation, cardiac defects, hemodynamics, and waveforms- just to name a few.
My favorite part of the conference was the lung protective workshop. For me this was the biggest take- away from the conference and a real eye opening experience that I just have to share! We were able to see several demonstrations of various types of ventilators (Servo, HFJV, HFOV) connected to preserved pig lungs. Compared to the human lung, pig lungs have an extra lobe called an 'accessory lobe' and have a larger surface area than a typical human lung, however; the alveoli (where gas exchange takes place) in pig lungs are smaller than a human therefore, requiring a smaller amount of volume of approximately 3ml/kg. Seeing how the lungs reacted to different levels of tidal volume and PEEP (positive end expiratory pressure) was incredible to say the least! It made me really think about how I am affecting a patient's lungs when I am making changes on the ventilator.
A major take away from these demonstrations was- VOLUME KILLS. We saw how adding too much tidal volume to a lung can cause overinflation resulting in blebs which ultimately can lead to a pneumothorax. Evident from the demonstrations, a patient will most often benefit more by determining their optimal PEEP. To determine optimal PEEP you want to titrate the PEEP up slowly and look for improvement in lung compliance. PEEP is used to improve oxygenation in patients with refractory hypoxemia. In addition, PEEP opens collapsed alveoli, thereby restoring the FRC, and decreasing physiologic shunting. Lung protective strategies implements low tidal volumes and higher PEEP. Patients with acute respiratory distress syndrome (ARDS) benefit from lung protective strategies by reducing hyperinflation and keeping the lungs open when possible. When using lung protective strategies you want to keep the patients plateau pressure <30mmHG. Assessing your patient and knowing when to implement lung protective strategies can be vital to delivering life-saving care.
- Pneumothorax: occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse. Symptoms usually include sudden chest pain and shortness of breath. On some occasions, a collapsed lung can be a life-threatening event.
- Bleb: a gas-containing space within the visceral pleura of the lung- a form of pulmonary air cyst.