Awesome, Selina! Thanks for watching and kindly commenting!

Awesome! That's what I like to hear. Glad you find the channel helpful. THANK YOU for watching and commenting, Paola!

Cool. You want be a newbie for long. Thanks for watching and commenting.

CONGRATULATIONS!!! Welcome to the field of RT. You are absolutely correct. You spend two - fours years learning all this stuff and then you graduate followed by a big exhalation of accomplishment, but that's only the beginning. Once working, the clinical application of all the knowledge you gained is required, and it's not a multiple choice exam, it's life. Staying engaged in the learning process post graduation is the key to developing into an extraordinary RRT. Your career depends on it, and your patients deserve it! The journey continues... Thank you for watching and kindly commenting. Best wishes!!!

Thank you for watching and for your kind comments. Good luck!

My pleasure! Thank you for watching and commenting!!

Hello Jeff and the Philippines!!!! Your very welcome. Glad you find them helpful. Thanks for watching and commenting!!!!

Thank you for sharing your kind words and watching. I appreciate you!

Thanks, Blanca! I appreciate your kind words. I do teach as a profession and do my best to help all students, either directly or indirectly. Thanks for watching and commenting.

Thanks and thank you for watching!

Awe, thank you for watching and for the kind comment. Glad to help! Best wishes.

Not sure what this says, but I love u!!!

Thank you for watching! Hope it helped!

Thank you, Kevin! Much appreciate you watching and commenting.

@@RespiratoryCoach I have reccomend your vedios even to my respiratory therapy graduating friends...its definitely gonna be helpful in our college exit exams and the future tmc and cse exams..

@@kevinvarghese2 Thank you, Kevin, for the recommendations. I appreciate you watching and commenting. Hope to hear more from you soon.

Glad you liked it!

It's on the list, Max. Thanks for asking!

Hello fellow RT veteran! You are 100% correct!!! I did misspeak at the mentioned times. Thank you for bringing that to my attention. I will make that correction in an updated video. No offense taken! I appreciate you watching and contributing. Thank you!

Hello! You're very welcome and thank you for watching. I don't think there is one patient population that PRVC benefits the most. I also don't have a problem with every patient being placed in PRVC. When it becomes a problem is when we fail to recognize the patients that PRVC IS NOT benefiting. Do we get them out of PRVC in those cases, or do we just let the p-v asynchrony continue to happen or give more sedation? I like the way you think. Don't get put in a box when it comes to a specific mode of MV. Hope this helps!!!

Thank you kindly!

Thank you for watching and commenting!!!! Best wishes!

Just a regular guy that happens to know RT and is willing to share with the others! Thank you for watching!

Got it. Will address soon! Thank you very much for watching and commenting.

Hi Mister M. Not at all. I think most of the time vent mode depends on provider and regional preference, rather than patient presentation. Personally, I like to start in a VC mode to allow me to assess raw and compliance. Your TMC almost always starts out in VC, but smart thinking and great question!! Thanks for watching!!!

Hi Munirah! The concept of weaning modes is constantly evolving, and to the point to where now evidence supports full mechanical ventilation with daily spontaneous breathing trials. So yes, PRVC should not be consider a weaning mode, but rather a pressure control mode with the thought of preventing volutrauma. Hope this helps!

Hello! Generated in the sense of triggered? Or the actual physics of the pressure change? Let me know so I can best answer your question. Thanks for watching and commenting, Tarundeb!

@@RespiratoryCoach actual physics of the pressure change... How a sudden peak pressure level is generated...

Thank you for the multiple comments. You're very, very welcome.

I believe it is. What vent do you primarily work with in your area?

@@RespiratoryCoach Draeger Infinity v500

Hello, use mean airway pressure from volume control to approximate where to begin pip in pressure control. Remember your COPDers have an increased compliance, so don't be shocked if they don't require much insp pressure to generate an acceptable tidal volume. Make sense?

Yes. Thanks for watching and commenting with your question.

That's the best I know how to explain it. Just makes sense, right?

Please explain about bias flow..?

You are VERY welcome!!! Thank you alot for watching!!!

The ability to control pressure while also maintaining a desired minute volume for adequate co2 removal.

@@RespiratoryCoach Thank you for your valuable answer to my question,I get better understand on this mode.

Hi Bailey! First, I love it when nurses show up and ask questions on this channel. So thank you for watching and for commenting. I've got your question noted and will get your video response out soon. Stay tuned!

Respiratory Coach thank you so much! I will keep an eye out for it!!

@@baileycoggins7986 Here ya go! kzfaq.info/get/bejne/fdSTlKVjqeCvlmg.html

I got you on the list. Stay tuned. Will answer soon. Great question by the way.

Yes. Both are closed loop, tidal volume targeted pressure control ventilation.

If they're continuously high then it means you either have a airway resistance problem or a alveolar compliance issue and the high pressures are needed to achieve the target tidal volume. If you don't want your pressures to be that high, adjust your pressure limit alarm so that the vent doesn't increase pressure beyond that point. However, something has to give, so when you do so, you understand that your target tidal volume will not be reached. Another thing to note is that you can decrease your target tidal volume, and make up for the volume by increasing your RR. Hope that helps. Thank you for watching and commenting with your question, Marv!

Respiratory Coach, please enlighten me.. The target Vt is set on 280 but VTi and exhaled VT is only 210. Set Rate already on 30. with high peak pressure and plateau pressure.. Blood gases are consistent with severe respiratory acidosis. What could be the possible problem why we never reached our target VT? Already explained to the doctor that the patient has stiff lung, but insisted that the problem is on the ventilator.

Hello! Great scenario based question. The first thing I would like to point out is that I'm not sure how the patient is able to generate a spontaneous breath in any AC mode. Of course, we know that they can trigger a breath in AC, but beyond that point the breath delivery is based on what is set. What I wonder might be happening is something that we commonly see in VC-AC. We set a tidal volume that doesn't meet the patient's neural drive to breathe. In other words, the vent gives the set tidal volume, but the patient isn't satisfied with that volume, so they immediately trigger another breath. This is what we call breath stacking. When we observe the exhaled tidal volumes, we'll see a very small exhaled Vt, followed by a very large exhaled Vt. For example, tidal volume is set at 400mL. Patient breath stacks. We might see an exhaled Vt of 25 mL followed by an exhaled Vt of 775 mL. All of that to illustrate what I think might be happening with your patients in PRVC. The fact that you're in AC-PRVC eliminates the option that those large tidal volumes, in between set breaths, are spontaneous breaths. Another possibility is that the patient's diaphragm is dropping faster than the breath is being delivered, which in PRVC will confuse the vent. The diaphragm dropping during a breath increases compliance, as opposed to a resting diaphragm during mechanical ventilation. In PRVC, an increasing compliance will lead to the vent decreasing pressure to assure delivery of desired tidal volume. The POTENTIAL problem here though is that your patient's diaphragm is dropping really fast in response to an unsatisfied neural drive to breathe. The patient is either volume or flow hungry, but has no control over either. So their neural drive says breathe harder. The longer they stay distressed the more distressed they become. The more distressed they become the faster their diaphragm drops. The faster their diaphragm drops the better their compliance is falsely perceived by the vent in PRVC, and the vent incorrectly continues to decrease pressure, which in PRVC decreases flow. Which is the exact opposite of really needs to happen. The patient needs more flow, which would require an increase in pressure to increase flow in PRVC. This may also explain why they fail their SBT. Despite blood gas results, the patient is neurally distressed. How often do you encounter this issue? Do me a favor. Email me a video or image of the scalar graphics (pressure, flow, volume) the next time you encounter this. Also, assess your patient's P0.1 (aka P100 or occlusion pressure). I would be shocked if wasn't excessively high. Your scenario here has intrigued me. Please keep me up to date as you figure this out. Hope this helped a little. I wish I could give you an absolute answer of what is going on, but without being in front of the patient and vent, I can only speculate based on past experiences and principles of mechanical ventilation.

@@RespiratoryCoach sorry didn't mean spontaneous breathe I meant patient triggered breath over set rate. I see all the time for example, patient pulling 500 VT with vc/ac prvc VT set to 380. Based on what prvc does, that pt is pulling those volumes due to his demand (as you stated) and since he's pulling higher than set VT, theres really no way to measure the amount of SUPPORT the patient is actually getting. I see this all the time. My issue is I cant measure any type of numerical support. And the thing is. Sometimes the patient isn't even in distress, they just want a higher VT. I wish I had a good argument as to why that patient needs to be switched to spontaneous mode. I'm a big believer in getting patient to spontaneous mode asap but providers I work with won't change from VC unless they pass sbt. Alot of times I know I could get the example patient mentioned above to look more comfortable on pressure support 10/5 but they say "theres no evidence based information" which unfortunately to my knowledge is true

Maybe try PAV? Not that it's anything greatly different, just another spontaneous mode, but it might shift the discussion from a PSV research based discussion.

@@RespiratoryCoach PRVC does allow a pt to take a larger Vt without a double trigger. If they do this then the machine will start backing pressure off. If the patient continues to breath above the target volume the pressure the machine delivers will keep dropping. So the patient is doing the work instead of supporting the paient. Some vents have a low pressure alarm that will alert us that the patient is not really being supported. You'll notice a low PIP maybe only 6 to 10 cm above the PEEP. I try to get them to switch to pressure support if this happens. BTW PB 840 vents you can turn that alarm off, but remember that the alarm is there for a reason and I reccomend not simply turning it off. The Dragar cannot be turned off. It makes you deal with the problem. A tricky mode to use. Must understand some more things even if you want to do it safely.

@@steves8860 Hi Steve. Thanks again for the contribution from a seasoned RT. Yes, fully aware of the patient's ability to receive a larger tidal volume than the target Vt. However, the patient does not have control of I time or flow. So in cases of asynchrony in PRVC, you might have a flow or volume hungry patient generating a larger than target Vt, which is decreasing pressure, and subsequently flow, in order to reduce Vt, but this actually becomes counter productive because the patient is actually wanting more support (flow or volume), not less. Have you seen this?

LOL....that little RT is actually busy being a real therapist!! Appreciate the comic relief, Veer!!!

Got it! Thanks for watching and placing a request.

So, if you're talking about the initial test breath when switching into PRVC, or any other time a test breath is delivered due to suctioning or broken circuit, then yes. That's only because the vent delivers a set Vt at a set flow and performs a insp hold to determine static compliance, which will determine what the very next breath looks like. Other than the test breath, an insp hold will not give you true representation of plateau pressure, because you'll be holding essentially a pressure control breath. Does this answer your question and make sense? Let me know if not and I'll try again. Thanks for asking!

Not sure if I understand what a “test breath” is ....would I be able to tell on the vent when it is given? Or if I hit manual breath will that be a test breath?

@@mariaholivella5058 Yes, you'll be able to tell. The test breath is a volume control breath with a insp pause. So your pressure waveform on the test breath will be a gradual incline with a plateau pressure observed. The purpose of this test breath is to establish a baseline starting point for all subsequent pressure regulated, time cycled breaths. Post test breath, your pressure waveform will become square as the breaths are now pressure regulated and time cycled, as mentioned before. Make sense?

Respiratory Coach Yes, I understand now. I never heard Inspiratory hold called a “test breath” so it threw me off. But I get it😊

@@RespiratoryCoach Can you add a video on how to initiate pressure control ventilation

No, no, absolutely not, just a normal guy with information to share and a willingness to help others. I do thank you for the kind comment and for watching!

My classes are going online now which I hate, but your videos seem to help me understand the basic concept very much which I thank you for.

@@Bibekshrestha3024 Hang in there Classes will resume as we know them. Just may be a minute. Keep learning and growing as a RT student. You will be an RRT!

Thank you🤝👏🏼

LOL or that! Thanks for watching Carlos.