Airway Pearl: Don't over-ventilate your patient

While gas exchange defines both oxygen delivery and CO2 removal, effective oxygenation can happen passively or actively as opposed to CO2 clearance which is more dependent on ventilation. Since our focus of acute airway management is on oxygen delivery and the nature of our care is "hurry up" we often over-ventilate our patients in our haste of trying to improve the deafening tone of the fallen sat. Without the feedback of quantitative waveform capnography and the fact that there is a pulse-ox lag between the real-time central and peripherally detected saturation our attempts to re-oxygenate cause bad things to happen. High pressure, high volume ventilations using a BVM will feed the stomach which will come back to haunt you and your patient with regurgitation and aspiration. Excessive CO2 clearance will threaten the acutely ill or injured brain. Waveform capnography is great however let this video be a mental imprint that the majority of reoxygenation with alveolar recruitment occurs within 3-6 gently delivered breaths. With ventilations above 10/min your likely causing downstream harm.

This is a view through a lung window we create with our clinical cadavers. BVM with PEEP low and slow:


 



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