Great piece regarding foley associated UTI. A few questions regarding suprapubic catheters... 1) What is the best way to obtain a urine sample 2) Should we treat a suprapubic cath the same as a foley and replace it if it's been in longer than 2 weeks to obtain clean urine 3) When should we not be touching/removing a suprapubic cath 4) Any general pearls to know regarding suprapubic catheters
In the vent talk, Swami says ACMV can cause metabolic alkalosis in patients who drive the vent at a high rate - he probably meant respiratory alkalosis.
Hi, I just listened to Ventilator 101 talk. I have a few comments. 1. SIMV is not a good ventilator mode (with or without pressure support). It has been shown in the literature to be responsible of more ventilator-patient dyssynchrony. This mode was develop for weaning and showed prolonged weaning... There is not utility in modern ICU for this mode, except maybe for intractable hiccups. 2. If you intubate a patient with a severe obstructive disease and are preoccupied with the possibility of breath stacking and majoring the auto-peep, stay in AC mode and sedate/paralyse the patient to take full control. I don't think that SIMV will help you. 3. Tough PC is probably suitable for ARDS patients, the most evidence favour a VC approach aiming for 6cc/kg. This is the best evidence we have for ventilator strategy fro ARDS patient and I think we should stick to it.
I am more than open to discussion/contre-agumentation
Jeff
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Stephen T. - October 5, 2015 9:38 PM
Great piece regarding foley associated UTI. A few questions regarding suprapubic catheters... 1) What is the best way to obtain a urine sample 2) Should we treat a suprapubic cath the same as a foley and replace it if it's been in longer than 2 weeks to obtain clean urine 3) When should we not be touching/removing a suprapubic cath 4) Any general pearls to know regarding suprapubic catheters
Thanks!
Dharmesh S. - October 6, 2015 9:53 PM
In the vent talk, Swami says ACMV can cause metabolic alkalosis in patients who drive the vent at a high rate - he probably meant respiratory alkalosis.
Jean-Francois S. - October 20, 2015 9:33 AM
Hi,
I just listened to Ventilator 101 talk. I have a few comments.
1. SIMV is not a good ventilator mode (with or without pressure support). It has been shown in the literature to be responsible of more ventilator-patient dyssynchrony. This mode was develop for weaning and showed prolonged weaning... There is not utility in modern ICU for this mode, except maybe for intractable hiccups.
2. If you intubate a patient with a severe obstructive disease and are preoccupied with the possibility of breath stacking and majoring the auto-peep, stay in AC mode and sedate/paralyse the patient to take full control. I don't think that SIMV will help you.
3. Tough PC is probably suitable for ARDS patients, the most evidence favour a VC approach aiming for 6cc/kg. This is the best evidence we have for ventilator strategy fro ARDS patient and I think we should stick to it.
I am more than open to discussion/contre-agumentation
Jeff