So at the last Flipping the Vent course, we had the treat to have guest faculty Dr. Gary Nieman give us a lecture on the basic science and physiology behind the TCAV(TM) method, and it was really fantastic, so I just thought it was worth sharing with everyone.
While no ventilation technique will save every patient with severe lung injury, it is time to forge ahead and take steps towards improving the mortality of ARDS, COVID or otherwise, which has stagnated in the last 15 plus years. While ARMA established that 6 ml/kg was better than 12 ml/kg, it really showed little else. By no means can that data be interpreted as being THE best way to ventilate EACH patient, but only that low VT is better than high VT.
We know that driving pressure correlates with mortality. We know that atelectrauma, more so than volu- or baro-trauma, is the main engine behind VILI. Hence those are the things we should be trying to minimize.
Here is Gary:
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