Michael Wang, PT, PhD

Intensive Care Physiotherapist, PhD, Proud father x2

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @DrMiguelIbarra1 @emireles_c @critconcepts @IM_Crit_ @Vent_Busters @OfVentilation @ventilacionmeca @HIventila @RespiratorySCCM @MegriMohammed prob have psync activated - which means patient triggered breaths will obliterate time triggered breaths

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @DrMiguelIbarra1 @emireles_c @DocMusician @ventilacionmeca @OfVentilation @Vent_Busters @IM_Crit_ @critconcepts @DrSateeshPCCM @HIventila @RespiratorySCCM @respiratory_RT1 @SaudiRTs @curso_vm I don't like it because it is only useful for a few hours after an uncomplicated surgery. I also don't like it because other people don't understand it and misuse it.

[Michael Wang, PT, PhD @MYTWang]

@jtrebach Gas under the diaphragm, something has leaked. No more fancy cocktails for me

[Michael Wang, PT, PhD @MYTWang]

@DocPriyamMD Wait are you telling me that my grandma was correct this whole time? Omg I am sorry Grandma!

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @DocMusician @DrMiguelIbarra1 @emireles_c @PulmCCfellows @IM_Crit_ @critconcepts @OfVentilation @Vent_Busters @ventilacionmeca @Srivatsa34 @MCastroSayat Multiple trigger on breaths 2&3. Does not look like early cycle and is not early trigger. So must be false trigger, maybe hiccups/water in tubing

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @ventilacionmeca @DocMusician @emireles_c @CCF_PCCM @critconcepts @IM_Crit_ @Vent_Busters @OfVentilation @DrSateeshPCCM @RespiratorySCCM @MayoVentilation @MegriMohammed @SaudiRTs Agreed, if this was an ARDS patient who need a high peep low Tv vent strategy, they need to be paralysed

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @ventilacionmeca @DocMusician @emireles_c @CCF_PCCM @critconcepts @IM_Crit_ @Vent_Busters @OfVentilation @DrSateeshPCCM @RespiratorySCCM @MayoVentilation @MegriMohammed @SaudiRTs there is also work shifting in the patient triggered breaths, mostly late inspiration, so more likely volume starvation rather than flow starvation.

[Michael Wang, PT, PhD @MYTWang]

@dtruongPT Some nice air bronchograms Don

[Michael Wang, PT, PhD @MYTWang]

@MrPitbull07 Bless. He is so cute.

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @ventilacionmeca @DocMusician @DrMiguelIbarra1 @emireles_c @CCF_PCCM @IM_Crit_ @critconcepts @OfVentilation @Vent_Busters @MegriMohammed @RespiratorySCCM @SaudiRTs @DrSateeshPCCM Looks like inspiratory work shifting due to a tiny ps of 3. The vent struggles to pressurise to the target PIP of 8

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @DocMusician @DrMiguelIbarra1 @emireles_c @CCF_PCCM @critconcepts @IM_Crit_ @MegriMohammed @OfVentilation @Vent_Busters @ATC_Ventilator @SaudiRTs @RespiratorySCCM but, on closer inspection, the Ti of the stacked breath is inconsistent with the VC breaths; the first (left-most breath that is half cut off) breath is not VC (flow pattern not pre-specified). So it must be SIMV-VC on the servo U, with flow adaptation turned on.

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @DocMusician @DrMiguelIbarra1 @emireles_c @CCF_PCCM @critconcepts @IM_Crit_ @MegriMohammed @OfVentilation @Vent_Busters @ATC_Ventilator @SaudiRTs @RespiratorySCCM flow adaptation turned on in Servo U may cause the middle breath to occur. My guess it's assist control volume control with flow pattern = 100% (constant) and flow adaptation turned on, and an inspiratory pause. An early trigger caused the anormally seen in the middle breath

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @emireles_c @CCF_PCCM @OfVentilation @SaudiRTs @RespiratorySCCM @MSRC_TexasState @DocMusician @MegriMohammed @RagingRenals maybe I read the question wrong but clinician can set x and the patient can trigger more on top? so x is not the minimum?

[Ross Prager @ross_prager]

(1/x) Performing ultrasound in zero gravity is harder than in the ICU...

Here's what we learned from studying AI ultrasound in zero gravity trying to detect celestial dust related lung injury 🌙🚀

A 🧵

Made possible by funding from @csa_asc

[Michael Wang, PT, PhD @MYTWang]

@MagnusCarlsen You are no dog, you are goat

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @DocMusician @DrMiguelIbarra1 @emireles_c @CCF_PCCM @OfVentilation @MegriMohammed @Vent_Busters @ATC_Ventilator That’s what I always try to teach! The only way most ventilators can deliver an exact volume is the controlling the entire flow waveform

[Michael Wang, PT, PhD @MYTWang]

@ArielG_RRT @ventilacionmeca @DocMusician @DrMiguelIbarra1 @emireles_c @CCF_PCCM @OfVentilation @ATC_Ventilator @critconcepts @IM_Crit_ @CJRTeditor @respcare @MegriMohammed @Srivatsa34 Mode is AC-VC, flow pattern set at 100% with adaptive flow option turned on
Early trigger - patient's inspiratory effort follows time triggers
The inspiratory efforts trigger PS during the constant flow VC breath delivery
Fix - reduce rate and change to a pressure-targeted mode