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 ventilation can dramatically improve patients with acute decompensated heart failure.

We move beyond dogma and into physiology—connecting ventilator settings to pulmonary edema. If you’ve ever wondered why positive NIPPV settings to flash pulmonary edema and how PPV affects the RV and LV.

 Cardiac mechanics Positive pressure as therapy Real ICU decision-making

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 to spot if we are violating our goals.

This is a small sample of the APRV webinar I did on December 9th !

Reach out to me on Instagram, @pulmtoilet, or [email protected] 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 overlooked!!!

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!