Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo

In this 142nd episode I welcome Dr. Marcos Vidal Melo to the show to discuss Driving Pressure and Transpulmonary pressure. We discuss what they are, how they differ from plateau pressure, and how they may help guide safe mechanical ventilation.

References:

  1. Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation? Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Anesthesiology. 2019 Jul;131(1):155-163. 
  2. Loring SH, Topulos GP, Hubmayr RD: Transpulmonary pressure: The importance of precise definitions and limiting assumptions. Am J Respir Crit Care Med 2016; 194:1452–7
  3. Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J; PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine): Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016; 42:1360–73
  4. Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, Guérin C, Patroniti N, Ranieri VM, Gattinoni L, Nava S, Terragni PP, Pesenti A, Tobin M, Mancebo J, Brochard L; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine): The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 2014; 189:520–31

Episode 71: Oral Board Prep 2: part 1

In this episode, episode 71, combined with the next episode, episode 72, I welcome back Drs. Tran and Beaudry to do an oral board prep example.  We got through how not to do it and then how to do it well.  This is part 1, episode 72 will be part 2.

The stem and questions are here: Oral board stem

Episode 59: Pulmonary HTN with Jochen Steppan

In this episode, episode 59, I welcome international pulmonary hypertension expert Dr. Jochen Steppan to the show to discuss pulmonary hypertension and how to manage the preoperative care of patients with this disease.

Outline by Brian Park: Outline

Episode 36: Pediatric respiratory anatomy and physiology with Dr. Schwengel

In this episode, episode 36, I welcome Dr. Deb Schwengel, one of our pediatric anesthesiologists and our residency program director, to the show to discuss the differences in anatomy and physiology in pediatric versus adult patients.

Episode 35: Pleural effusions with Dr. David Feller-Kopman

In this episode, number 35, I welcome Dr. David Feller-Kopman to the show.  Dr. Feller-Kopman is an associate professor of medicine and Otolaryngology and the director of Bronchoscopy and Interventional Pulmonology here at Johns Hopkins.  I interview him about pleural effusions including what they are, where they come from, how to categorize them, how to treat them and how to deal with them if they recur.

The NEJM article on the use of TPA and DNAse is here: http://www.nejm.org/doi/full/10.1056/NEJMoa1012740#t=abstract

Episode 25: Advanced Ventilator Modes With Dr. Scott Stephens

In this episode I am joined once again by Dr. Scott Stephens as we review advanced ventilator modes, prone positioning, and ventilation of patients on VV ECMO.

The fantastic review article I mentioned is: Mireles-Cabodevila E. Et al. Alternative Modes of mechanical ventilation: A review for the hospitalist. Cleveland Clinic Journal of Medicine. 2009(75);7:417-430.

Pubmed link here

Episode 23: Basic Ventilator Review with Dr. Scott Stephens

In this episode I welcome Dr. Scott Stephens, Pulmonary Critical Care Physician at Johns Hopkins to the show. Dr. Stephens and I discuss basic ventilator settings, how to appropriately ventilate patients with hypoxemic vs. hypercarbic respiratory failure and how to think about weaning patients off of the ventilator.

Outline by Brian Park: Outline