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, compliance, or patient effort. Instead of memorizing patterns, this episode teaches you how to think through the waveform so you can quickly identify what’s wrong at the bedside.

If you’ve ever looked at a ventilator and felt like something was off but couldn’t quite explain why, this episode will sharpen that instinct and give you a framework you can apply immediately.

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 the respiratory drive tells you things that tidal volume and respiratory rate simply can't — how hard the brainstem is working before flow has even begun. We break down the physiology behind it, walk through how to measure and interpret it, and explore how P0.1 can serve as both a trigger-sensitivity troubleshooting tool and a real-time gauge of patient effort and diaphragm load.

Along the way we tackle practical questions: what P0.1 thresholds should raise concern, how autotrigger and elevated drive interact with patient-ventilator asynchrony, and when you should let the number change your clinical decisions. Whether you're a fellow just getting comfortable with modes and waveforms or an experienced intensivist looking for a sharper framework, this episode gives you a cleaner mental model for one of ventilation's trickier corners.

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

You can find the full episode for FREE on YouTube, Spotify, and Apple Podcasts

Search “The Peak Inspiration” or find it through @pulmtoilet

If you watch or listen, I’d genuinely like to hear what you think.
What made sense, what didn’t, and what you want covered next.

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 just moving the needle earlier without improving outcomes
• Blood cultures before antibiotics: Dogma vs reality when time, access, and patient stability are working against you

This isn’t a guideline summary. It’s a practical discussion about where the evidence is strong, where it’s weak, and where clinicians are still forced to make judgment calls in real time.

If you’ve ever wondered whether you’re practicing evidence-based medicine or just following momentum, this episode is for you.

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, pain, sedation washout, and cardiac function distort the data
• The hidden hemodynamics of liberation
• Why diaphragm performance matters more than a single respiratory rate
• And how over-reliance on protocol can blind us to physiology

Because at the end of the day, extubation is not decided by a spreadsheet. It’s decided at the bedside.

By watching the patient. By reading subtle cues. By integrating ventilator data with work of breathing, mental status, secretion burden, airway protection, and trajectory.

SBTs are a test of physiology — but they’re also a test of clinical judgment.

Dont fall into the trap of : "better luck tomorrow"

#floatingventguy

IG: @pulmtoilet

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!!!