Tutorial 7: Ventilation, Ventilatory Failure, Ventilation Perfusion Matching and Dead Space

Clinicians who work in anesthesiology, intensive care or emergency medicine who are involved in the management of respiratory failure must understand the problem of failure to ventilate: "can't breathe, won't breathe." This long tutorial covers a lot of ground and could be viewed in split sessions. My principle goal is to give you the tools to work the problem of respiratory failure. Along the way I introduce the alveolar gas equation, ventilation perfusion matching and lung volumes; particularly functional residual capacity. In the second half (from 28:20 onwards), I discuss anatomical and physiological dead space, calculate out the dead space to tidal volume ratio and show how you can be inadvertently increasing physiologic dead space by applying PEEP or neglecting auto-PEEP. Even if you think you know a lot about this subject, I guarantee that you will learn something. @ccmtutorials www.ccmtutorials.org Content: 01:05 Review of Previous Tutorial (volume controlled modes) 01:40 Contents of this Tutorial 02:45 Clinical Scenario - Freida, in the operating room, not breathing 03:20 Why Do We Breathe? 04:25 Respiratory Failure 06:05 The Transit Airways 08:55 Normal Ventilation Perfusion Relations 11:30 Failure to Generate Adequate Alveolar Ventilation 18:20 Failure to Clear CO2 Despite Apparently Adequate Alveolar Ventilation 18:58 Alveolar Gas Equation 24:00 Lung Volumes 28:25 Dead Space to Tidal Volume Ratio 29:30 Ventilation Perfusion Matching and Distribution 37:20 Clinical Scenario Renewed 40:10 Dead Space Ventilation and Increased PaCO2 45:30 Clinical Scenario - Developments 47:25 Impact of PEEP on Ventilation Perfusion Matching 50:00 Auto-PEEP 53:30 Review 55:05 Preview of Next Tutorial (supplementary tutorial on end tidal CO2 monitoring)