About this episode

Mike Brown and Jesse Carroll discuss ventilatory management for DKA and metabolic acidosis in prehospital settings.

Mike Brown and Jesse Carroll from Hamilton Medical break down ventilatory management for the DKA patient and other metabolic-acidosis presentations in the prehospital setting. They focus on why minute ventilation, not just rate, matters when you take a patient's airway: match or exceed the patient’s compensatory minute volume, size tidal volume to ideal body weight), and account for dead space. Practical demos cover when to favor a mechanical ventilator over BVM, using NIV-ST to support fatigued spontaneous breathers, and how to set tidal volume and rate to replace 17–20 L/min minute volumes seen in severe hyperventilation. They also unpack the ICEBERG Study and the concept of driving pressure, why driving pressure may better reflect lung stress than plateau pressure alone, and why higher driving pressures are associated with worse outcomes. The discussion reviews current evidence supporting efforts to keep driving pressure low when clinically feasible.

People in this episode

Guests: Mike Brown, Jesse Carroll

Topics covered

• ventilation management
• DKA
• metabolic acidosis
• prehospital care
• mechanical ventilation
• driving pressure

Keywords

• ventilation
• DKA
• metabolic acidosis
• minute ventilation
• driving pressure
• mechanical ventilator
• NIV-ST
• hyperventilation

Mentioned in this episode

Organizations: Hamilton Medical

Books & works: ICEBERG Study

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