Critical Care Scenarios Lightning rounds 48: Complete airway closure with Thomas Piraino
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Dec 25, 2024 In this discussion, Thomas Piraino, a respiratory therapist and expert in airway management, delves into the nuances of airway closure during mechanical ventilation. He highlights the challenges posed by this phenomenon in critical care, especially in conditions like ARDS. Topics like the significance of optimizing PEEP levels, the intricacies of volume-controlled ventilation, and the analysis of ventilator waveforms are covered. Thomas also emphasizes the importance of using collaborative approaches for effective airway management and improving patient outcomes.
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Airway Closure Is A Separate Phenomenon From Alveolar Collapse
- Complete airway closure is when proximal airways stop communicating with distal airways while alveoli may remain inflated.
- The airway opening pressure must be exceeded by PEEP or inspiratory pressure to ventilate those regions, changing driving pressure interpretation.
Airway Closure Makes Driving Pressure Misleading
- Airway closure makes driving pressure and respiratory-system compliance appear worse if PEEP is set below the airway opening pressure.
- Measured driving pressure includes the pressure used just to overcome closed airways, so it can be a misrepresentation.
Lower Inflection On PV Curves May Represent Airway Opening
- Lower inflection points on slow pressure–volume curves can reflect airway opening pressure rather than alveolar recruitment.
- Overlaying a blocked-circuit PV curve showed the patient curve follows the circuit until the airway opens.