Lung Protective Tabulations Multi-touch book

Lung Protective Tabulations now availabe as a multi-touch books on iTunes (see link below).

LUNG PROTECTIVE TABULATIONS

Limiting Driving Pressure

Pressure Control Setting For Targeting Tidal Volume per Ideal Body Weight [1].

Driving pressure has been shown to be a better determinant of ARDS outcomes than tidal volume, plateau pressure, or PEEP. "A driving pressure > 14 cmH2O was associated with increased 60 day mortality" [1].

Titrating tidal volume to maintain driving pressures < or = to 14 cmH2O with minimal costs in regards to CO2 clearance is a practical strategy to reduce the risk of volutrauma [1].

The practitioner can easily meet this target by utilizing Pressure-control ventilation and never setting the pressure > 14 cmH2O.

The above set of tables "Pressure Control Setting for Targeting Vt/Kg IDBW" displays the relationships between tidal volume, compliance, and pressure control setting (driving pressure). These tables can be used a few ways: 
1. To determine the PC setting to target a specific VT for a measured compliance.
2. If using Volume-control (fully decelerating flow pattern only) or a Adaptive Pressure-control
(e.g. PRVC, Auto-Flow, APV, VC+) predicts what the driving pressure will be for your set VT based on measured compliance. 
3. Titrating tidal volumes to maintain driving pressures < or = to 14 cmH2O.

Inputs- height (inches or centimeters), VT target (4, 5, 6, ml kg), compliance, gender. 
Outputs- IDBW (KG), VT/Kg (ml), Driving pressure. 

REFERENCE
Richey KS. Lung Protective Tabulations, 2018

MINIMIZING THE RISK OF VOLUTRAUMA

Ideal Body Weight & Tidal Volume Tables[1].

The aim to minimize the risk of volutrauma is associated with the objective to optimize the pressure/volume curve. To accomplish this the clinician targets a minimal tidal volume and optimal PEEP which maximizes compliance and avoids volutrauma as well as atelectrauma.

One strategy to reduce the risk volutrauma is to target a tidal volume of 4 to 6 ml/kg/Ideal body weight per ARDS net guidelines
.
The pictured group of tables "IDEAL BODY WEIGHT & TIDAL VOLUME Per Ml for both genders" [1] provide tidal volume targets of 4,5,& 6 ml/kg/IDBW.

Inputs- Height (inches or centimeters) & Gender.Outputs- Ideal body weight (kg), target tidal volume (4, 5, 6 ml/kg).

Reference
1. Richey KS. Lung Protective Tabulations 2018

Hypoxic & Hyperoxic Guard

Predicted PaO2 Table setup as a Hypoxic & Hyperoxic Guard. 

Maximizing oxygenation to prevent hypoxia and hyperoxia can be accomplished by titrating FiO2 to target a optimal paO2 goal. Practitioners often consider a liberal oxygenation strategy of a target SPO2 > 95% & consider hyperoxemia acceptable. Conversely, "hyperoxia and hyperoxemia may promote lung injury during mechanical ventilation and lead to poor outcomes" [1].

The above table "Predicted PaO2" from my new reference [1] is color-coded and setup as a "Hypoxic & Hyperoxic Guard", the tables are based on a more conservative oxygen strategy of a PaO2 target of 60-100. Additionally, the tables
where created using a newer formula which allow for more accuracy in the presence of shunts.

Inputs- Old FiO2 (starting FiO2), Old PaO2Outputs- predicted PaO2 for new FiO2 settings 25-100%

1. Richey KS. Lung Protective Tabulations, 2018

FREE MECHANICAL VENTILATION COURSE

FREE MECHANICAL VENTILATION COURSE

Courtesy of Robert Chatburn & the Cleveland Clinic 

From Robert Chatburn:

My colleagues and I at Cleveland Clinic have been developing a standardized system to teach basic mechanical ventilation technology, over the last decade. We have now completed a 12 module, self-directed course (PowerPoint files) and a ventilator simulator (Excel file) that contains links to many additional resources.

We offer both freely (no strings attached) with the intent of improving the lives of patients through better understanding of those who serve them; clinicians, educators, researchers, and engineers

To access these tools, do the following:

The Basic Course in Mechanical Ventilation and SIVA ventilator simulator are now available on the MyLearning website at Cleveland Clinic.

This course is best viewed using Internet Explorer. If using Google Chrome, please make sure the Adobe Flash plugin is installed.

Please log into https://mylearning.ccf.org to access the course. The course can be found under the Find Learning tab by searching for the course title. The course is open for self-enrollment.

You can also access the course by clicking on the direct link https://mylearning.ccf.org/course/view.php?id=1320.

If you have not yet created a password to log into MyLearning, please follow the instructions shown below.

Feel free to contact elearning@ccf.org if you have any problems accessing the course.

MyLearning Password Instructions

1.      Click the link https://mylearning.ccf.org/login/index.php

2.      If you are NOT a Cleveland Clinic employee (do not have a CCF employee id#), Click Create New Account and follow instructions.

3.      If you are a Cleveland Clinic employee OR non-employee that may already have an account from mCOMET, click the Existing Account button. Anyone with a CCF employee id# or a non-employee ID# (e.g., student, contractor, vendor) will automatically have an account. Enter one of the following depending on your employment status: 

o    Cleveland Clinic Employees: Enter your Cleveland Clinic employee ID in the Employee id field

o    Non-Cleveland Clinic Employees: Enter your email address (used in mCOMET) in the Email address field

4.   Click the Search button

5.      A message displays, click the Continue button

6.      Check your email for further instructions (This may be your ccf.org email or a personal email depending on which one is your contact email in your HR record. Please also check your Junk email)

7.      In the email, click the link provided

8.      The Set password screen displays, enter a new password following the instructions provided

9.      If the password is accepted you will be automatically logged into the MyLearning site (Save the site to your Favorites/Bookmarks)