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

4 Replies to “Episode 25: Advanced Ventilator Modes With Dr. Scott Stephens”

  1. Fantastic talk, as always! What about using the oscillator as alternative mode of ventilation? I have seen oscillators used after APRV in severe ARDS with refractory hypoxemia, especially in pediatric patients. It would be great to hear a bit about them! And, an ECMO podcast would indeed be excellent!

    1. Hi Stephen, great question. HFOV (the oscillator) is used a fair amount in pediatrics but in adults it is used much less than it once was due to the results of two large randomized trials published in the NEJM in 2013. One was the OSCILLATE trial and the other was the OSCAR trial. The OSCILLATE trial had higher mortality in the HFOV group and the OSCAR trial had no improvement in mortality in the HFOV group. Taken together the conclusion is that there is no benefit, and possibly harm, to HFOV in adult patients with ARDS. As for ECMO, it’s definitely on the list for its own episode at some point.

      Thanks for the comment, and, of course, for all you do out there every day.

      Best,
      Jed

  2. Can you “auto peep” on APRV? In other words, if you T(high) to T(low) ratio is too high and not allowing sufficient time for expiration, despite the fact that there is an open exhalation valve allowing for spontaneous breathing, can you progressively increase your pulmonary pressure?

    1. Hi Glenn, I suppose that could happen, and many feel that APRV is contraindicated in COPD patients for that reason. In practice it is rare because you can always exhale at any point.

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