Ventilator and Pulmonary Mechanics Chalk Talk Series

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Welcome to the Ventilator and Pulmonary Mechanics Chalk Talk Series, where we are learning how a ventilator works, and how to work a ventilator.

This series was developed as a spin-off of “bedside” teaching sessions with medical students and interns on their clinical anesthesiology rotation, where hands-on ventilator management is encouraged from day 1. For that reason, this series builds up complexity both in ventilator mechanics and in pulmonary physiology in parallel.

We start with a paralyzed, healthy patient connected to a basic, bellows-driven ventilator. Throughout the series, both the patient and the ventilator become more complex, until we’re treating an ARDS patient using the tricks of a modern ICU ventilator. As we progress, we alternate between pathophysiology-heavy lectures and nuts-and-bolts ventilator talks, so that we can put every new physiology tidbit we learn into practice with minimal delay.

The first ten lectures build an understanding of conventional ventilator modes, pathologic mechanisms of hypercarbia and hypoxemia, and how to manipulate ventilator settings to correct respiratory failure. Future lectures will focus on challenging or advanced ventilator scenarios, including the acute respiratory distress syndrome, severe restrictive disease, and extreme obesity.


The Basic Ventilator

Duration: 25:28 616

VPMCTS 1: Build a basic model ventilator, and use Ohm's law to understand the pressure- and flow-time behaviors of pressure control and volume control modes.

Compliance and Resistance

Duration: 23:28 777

VPMCTS 2: Explore the physiology of compliance and resistance, use peak and plateau pressures for clinical diagnosis, and avoid auto-PEEP.

PC & VC: Clinical Considerations

Duration: 14:01 277

VPMCTS 3: Explore the advantages and disadvantages of pressure and volume control, with a focus on changes in the patient's pulmonary compliance.

Advanced Conventional Modes

Duration: 13:25 283

VPMCTS 4: Combine the "best" of pressure and volume control: "ramped" volume control, pressure regulated volume control, and volume assured pressure control.

Patient-Triggered Breaths

Duration: 19:53 378

VPMCTS 5: Understand the mechanics of patient-triggered breaths in assist and assist/control, pressure support, and IMV and SIMV modes.

Computer Adaptive Modes

Duration: 9:49 196

VPMCTS 6: Computer controlled ventilator modes: Volume Support, Proportional Assist Ventilation, Automatic Tube Compensation, and Mandatory Minute Ventilation.

The Alveolar Gas Equation

Duration: 21:33 861

VPMCTS 7: Look at the relationship between alveolar CO2 and ventilation, and derive the alveolar gas equation. Examine hypoventilation and insufficient inspired oxygen.

Causes of Hypoxemia

Duration: 27:49 622

VPMCTS 8: Dive into causes of hypoxemia: hypoventilation, insufficient inspired oxygen pressure, diffusion insufficiency, ventilation-perfusion mismatch, and shunt.

Setting the Vent I: Ventilation

Duration: 22:23 558

VPMCTS 9: Treat hypercarbia by increasing minute ventilation. Examine the trade-offs of auto-PEEP, increased plateau pressure, and truncated inspiration.

Setting the Vent II: Oxygenation

Duration: 24:58 2895

VPMCTS 10: Optimize oxygenation using PEEP and FiO2. Get an introduction to ventilator-induced lung injury.