Vents 201 Part VI: Lung Injury Physiology

In this monologue podcast, Sara Crager delves into the complexities of ventilator management for lung injury, emphasizing the critical concept of alveolar recruitment. She explains how hypoxemic respiratory failure often results from alveoli being filled with something other than air, alveolar membrane issues, or alveolar collapse, leading to the characterization of injured lungs as "baby lungs" due to widespread derecruitment. Crager discusses the importance of PEEP in alveolar recruitment and preventing adelectotrauma, cautioning against over-aggressive recruitment maneuvers. She introduces the concept of airway opening pressure, which is higher than the PEEP needed for maintenance, and the potential for a cycle of recruitment and derecruitment. Crager advocates for the clamp switch technique to maintain recruitment during ventilator disconnections. She also details methods for determining optimal PEEP, including PEEP titration using driving pressure, static compliance, and analyzing pressure volume waveforms for inflection points and beaking, highlighting the challenging nature of finding the perfect PEEP setting.