The Peak Inspiration Podcast

A clip of my webinar that I did on PRVC and why adaptive modes are generally bad in the ICU. Want full webinar? Email ME! pulmcritnick@gmail.com

Running back my talk from ResusX about ventilating severe acidosis! I try to approach this from a pragmatic perspective! Nothing will work great so just do the least bad thing!!

We all know SIMV sucks, but what exactly is the difference between SIMV and AC?

My thoughts on a waveform question from April 17 on my Instagram @pulmtoilet !!! Go check it out !

In this episode of Peak Inspiration , we’re bringing you a high-yield excerpt from the Pressure Control Part 2 webinar, focused on one of the most practical skills in mechanical ventilation—recognizing abnormal waveforms. We break down how to interpret pressure, flow, and volume waveforms through the lens of the equation of motion, helping you pinpoint whether the issue lies in resistance, complia...

When the ventilator triggers a breath the patient didn't ask for, something has gone wrong. In this episode we dig into  autotrigger : why it happens, how to spot it at the bedside, and the cascade of harm it can set off when it goes unrecognized. Then we turn to one of the most underused numbers on the ventilator screen: the  airway occlusion pressure (P0.1) . This 100-millisecond window into...

Intro to mechanical ventilation is out now. This is a true starting point. No fluff, no overcomplication just the fundamentals you actually need when you’re at the bedside making decisions. We break down What each ventilator setting actually does How to choose initial settings without guessing Volume vs pressure modes in a way that finally clicks How to recognize when things are going wrong early...

Sepsis care keeps evolving but not always in ways that feel clean or universally agreed upon. In this episode, I break down the latest Surviving Sepsis Campaign guidelines what actually changed, what didn’t, and what matters at the bedside when the patient in front of you is crashing. We focus on two of the most debated areas right now: Prehospital antibiotics : Are we truly helping patients or ju...

My approach to ventilating severe metabolic acidosis! Often needing to balance harm of the acidosis with harm of the ventilator and creating a balance of these 2 forces while we fix the underlying pathophysiology!

Spontaneous Breathing Trials aren’t just a checkbox before extubation. They’re one of the most nuanced and most misunderstood checklists in critical care. In this episode, we unpack why SBTs are not simply “pass or fail.” A patient can “pass” the numbers and still fail at the bedside. They can “fail” and still be extubatable. We dive into: • Why the RSBI isn’t about extubatability • How anxiety, p...

If your PEEP strategy is: “ARDSnet table + hope for the best” …it’s time for an upgrade. This webinar walks through how to personalize PEEP in ARDS using compliance, stress index, PV curves, and bedside clues you can use on your next shift. #floatingventguy

Podcast I did with Escola de Intensiva about vent management in the obese ARDS patient and COPD!

First 45 min of the PC webinar!!!

Response to a reel that Kali Dayton posted about a nurse who is burned out in the ICU due to poor A-F bundle implementation. TLDR: We need to do better

Triggering the ventilator is how the ventilator knows to go from expiration to inspiration. Theres a few ways we can trigger the breath and some dssynchronies associated with it. In this episode, I go over these concepts!

Positive Pressure & the Failing Heart  Positive pressure ventilation is one of the most powerful tools we use at the bedside. In this episode, I sit down with  critical care cardiologist Willard Appelfeld, MD  to unpack how positive pressure ventilation interacts with the failing heart. We break down preload, afterload, venous return, RV–LV interactions, and why CPAP, BiPAP, and invasive venti...

When we are aiming for a lung protective strategy, it's important to note what exactly we mean when we say lung protective. Its also important that we follow the ventilator waveforms to ensure we are protecting the lungs with the settings we provide. You can call a vent strategy lung protective… but the alveoli will be the judge. We dive into the importance of reading waveforms and being able...

This is a small sample of the APRV webinar I did on December 9th ! Reach out to me on Instagram, @pulmtoilet, or pulmcritnick@gmail.com for more information !!

Whether you're a seasoned intensivist or just beginning to decode ventilator waveforms, this case-driven episode will give you the confidence to recognize and reverse auto-PEEP before it snowballs into hemodynamic collapse????

Ashley and I go over some ventilator questions that were sent in by you ! We take a deeper look into some settings, what about the managment of the ventilator is most challenging, and how we can all work better together to deliver the best patient care in the setting of invasive mechanical ventilation !

Ever stared at a ventilator screen and felt like it was speaking another language? You’re not alone. In this episode of The Peak Inspiration , we break down the mystery behind every number, waveform, and alarm flashing on that monitor. We’ll cover what each parameter means, how to find what you need to report on rounds or to an attendings, and a little known secret of the alarms that is often over...

In this episode, we go over the fundamentals of autopeep starting with the basics including the mathematical fundamentals that underpin this concept

We start off The Peak Inspiration Podcast with "how do we breath". A quick primer on negative pressure breathing, which is where we will build to positive pressure breathing and the mechanical ventilator!