Category Archives: Respiratory

ESICM Webinar: How to ventilate in COVID-19

Luigi Camporota, UK


My twitter thread on the webinar

The phenotypes of the disease and the time course

Remember, spontaneous breathing is not always a good thing…..

A stepwise approach to mechanical ventilation…

In conclusion…




And FOAMecmo’s beautiful infographic


Mechanical Ventilation – Basic to Advanced (Masterclass)


  • Controlled MV settings: basics
  • How to assess respiratory mechanics at the bedside
  • Strategies to set PEEP and to achieve lung recruitment

Revisiting the basics of mechanical ventilation with a nice quiz at the end…

Highly recommend   – great (free), short videos on mechanical ventilation


Recruitment Manoeuvres: 3 ways of doing it ….

  • sustained inflation
  • pressure controlled ventilation
  • incremental (decremental) PEEP trial

The ART trial highlighted the potential dangerous of recruitment manoeuvres. It’s effect may be dependant on determining which patients have recruitable lungs in the first place….

IMG_5706 IMG_5707 IMG_5708 IMG_5711 IMG_5713


@luigi_ICM  suggests that an assessment of potential lung recruitability MUST be performed prior to RM.


Do you know your respiratory mechanics equation??

IMG_5717 IMG_5718 IMG_5719


Master Class: Beyond BASIC mechanical ventilation: From the essentials to advanced respiratory support #EuAsia18

The twitter feed can be found here

Screen Shot 2018-04-12 at 08.01.46

The physiology of ARF

Consideration of oxygenation and ventilation as separate components

Effects of MV

  • Increase VA/Q
  • Decrease elastic workload
  • Decrease resistive workload

Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment (2018) –

Comparison of definitions –

Phases of ARDS


The principles of controlled mechanical ventilation

Ventilator detects flow and pressure (sensors)

P(open alveolar) = P(resistance of the airway) + P(elastic resistance of the alveoli)

Modes – volume vs pressure (hybrid = pressure regulated volume controlled ventilation)

Volume controlled ventilation

IMG_3049 IMG_3050

Pressure drop between peak and plateau pressure is reflective of airway resistance

Pressure controlled ventilation


Which mode of ventilation is ‘better’ does not matter as there is no difference in plateau pressure BUT could/should square vs decelerated flow (may contribute to a difference)


Hybrid modes may have share the benefits of both (constant Vt + decelerated flow)




The correct strategy for ARDS



The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia –

Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis –

Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial.

There was a discussion on Stress/Strain which I admit I don’t consider regularly…..

IMG_3056 IMG_3057

Support therapy in ARDS


Aetiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicentre study:

Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol: A Randomized Controlled Trial:

Sedation summary

  • Keep pt awake/light
  • If deep sedation required – avoid benzos
  • Protocol-based

Volatile sedation in the intensive care unit: A systematic review and meta-analysis

Proning –


Steroids and other adjuvant therapies

Effect of Prolonged Methylprednisolone Therapy in Unresolving Acute Respiratory Distress Syndrome: A Randomized Controlled Trial:

Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis.

Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature

Salbutamol: Inhalation therapies in acute respiratory distress syndrome –

Surfactant: Exogenous natural surfactant for treatment of acute lung injury and the acute respiratory distress syndrome.

NAC: Effects of N-acetylcysteine treatment in acute respiratory distress syndrome: A meta-analysis  –


  • Neutrophil esterase inhibitors
  • Granulocyte macrophage CSF
  • Interferon
  • Stem cells

ARDS: challenges in patient care and frontiers in research: