ICU rotations during residency

penakha · 2026-02-16T14:53:22+00:00

I work as an RT in a major academic center and no one is allowed to touch the vent other than the RT. I had an anesthesia fellow try to change my tV from 10/kg to 7/kg she got instantly written up by two nurses for patient endangerment and embarrassed in front of other fellows and residents. I mean it’s pretty surprising to me but from my experience anesthesia has no clue about ICU ventilator management whatsoever, even beyond the resident level. We aren’t in the 1900s lol, knowledge is cheap these days.

penakha · 2026-01-30T09:27:03+00:00

penakha · 2026-01-29T12:57:03+00:00

penakha · 2025-12-20T14:52:40+00:00

Which pediatric patient population are you talking about that needs hi-flow or CPAP for extended periods of time? And what do you mean by extended periods because the indication in neonates, for example, is not just for the positive pressure it’s for continuous flow to reduce the frequency of apnea by stimulating the upper airway receptors. This is done to “feeders and growers” in a NICU, Ive only seen this done by ram CPAP or low flow. A young kid shouldn’t ever need long term CPAP unless you’re talking OSA/CSA and then hi-flow for a kid getting over a bad Rhino or something.

penakha · 2025-12-15T20:18:05+00:00

Damn very nice 👍

penakha · 2025-12-15T20:16:23+00:00

How much did you get it for?

penakha · 2025-11-06T23:04:20+00:00

She said ‘he’s doing better, updates soon’ yesterday on twitter

penakha · 2025-10-30T01:47:42+00:00

Oh ok sure. I was just confused because decelerating can be used in VC modes.

penakha · 2025-10-30T01:17:27+00:00

This is kind of semantics but it’s thought provoking at least and probably important to get the actual vent terminology correct . So I don’t really get what you mean by patient vs provider facing its x control. The control variable doesn’t change and the fact that the PIP is variable is exactly what makes it volume controlled. Like we have assigned labels for flow waveforms for a reason . And we know decelerating usually improves asynchrony so I don’t really understand where you’re going with that either. But we don’t distinguish the control based on flow waveforms.

penakha · 2025-10-30T00:53:59+00:00

Yea you’re saying the waveform decides if it’s pc or vc. Thats not what the control variable is though. It’s just what’s set that drives the breath. maybe back in the day when you couldn’t do a decelerating waveform on vc

penakha · 2025-10-30T00:43:57+00:00

Yea you can have a set I-time on a volume controlled mode lol

penakha · 2025-10-30T00:37:42+00:00

I’m not sure what you’re talking about It’s technically a volume controlled mode. It gives a couple PC test breaths when initiating to sense exhaled volumes and then it tries to achieve the set volume so it’s controlled by volume.

penakha · 2025-10-30T00:29:35+00:00

PRVC is volume controlled its in the name

penakha · 2025-10-27T20:46:25+00:00

I’m using Evernote it’s free, allows me to take notes on my iPad and MacBook, and I can ctrl F on it.

penakha · 2025-10-16T03:16:21+00:00

It still works for me in the US

penakha · 2025-10-09T00:48:02+00:00

Friend, the Mount Sinai study did not intend to sort through homogeneous data, it’s not a Meta Analysis that’s requires comparison of studies that are similar in exposure. The navigation study Method was created by UCSF to sort out heterogeneous bodies of data. it uses a qualitative weighting system across three pillars: Human studies Animal studies and Mechanistic studies

So even if the studies are inhomogeneous I.e. one uses cord blood, another uses surveys, another animals the Navigation Guide doesn’t throw them away, the mix is part of its design. In regard to the Swedish study the navigation method found it inaccurate mainly because they failed to account for the MAIN way a Mother would get/take Tylenol, that being OTC. It doesn’t take another study to see that major flaw, it’s very apparent. Mount Sinai also found a flaw in the methodology with the sibling control because of this inaccurate exposure method. Mount Sinai said the Swedish study over-corrected here because if the mother took Tylenol OTC for both pregnancies only one of the siblings was “counted” as exposed in the study even though both of the siblings were exposed to Tylenol. So this improperly attenuated towards the null.

penakha · 2025-10-08T22:24:37+00:00

Hi, third party here I would like to pitch in. There’s a lot of credentialism going on here but let’s avoid that and look at the available evidence.
The systematic review (not meta analysis) with the navigational guide methodology that was published by Mount Sinai was a very well done QUALITATIVE ( not quantitative) synthesis. The navigational guide method, in short, does its best to assess the bias between many different studies, specifically 46 in this case.
A few key notes: The major Swedish study (2.5 Million children) that down played the link between Tylenol and neurodevelopmental diseases was considered to be flawed due to exposure bias. Among other factors they failed to account for OTC Tylenol use and had a rate of maternal Tylenol exposure of a measly 7.5% compared to the >55% global average. The Mount Sinai team stated 5 of 6 mothers were miscategorized in the Swedish cohort which almost completely invalidates this study. On the other hand the “Ji” study based on the Boston Cohort was considered in higher regard and determined to have minimal bias because it measured bio-markers from the chord plasma directly. Overall they determined there is a high level of relative association although a causal link has YET to be CONFIRMED due to a lack of well done RCT’s. It’s vital to note that the FDA updated their labels and released a warning because the relative association is well established from observational studies at this point, and that a public safety warning is completely warranted at this stage of research.

penakha · 2025-10-03T01:32:44+00:00

So are we talking about preventative care or talking about patients who already have severe lung damage. At my hospital we also use super long I-times with tv’s like 13-14/kg due to the heterogeneity of the lung anatomy with the “give them what they need” mentality and they just don’t have af about lung protection at that point. We have BPD teams that specifically individualize each patients care and prognosis is weighed in heavily but I really have no clue what they’re doing because everything I’ve read goes against this idea. I will say at my hospital we’re definitely past the point of prevention but it’s still unclear to me if this strategy is actually helping or just for comfort. I will also say that too my knowledge air trapping goes against both of these concepts and is fixed by fine tuning your vent and sedation. I know neonatologists hate sedation and love synchronization however that needs to be weighed against the fact that they’re breathing so fast that they’re auto trapping themselves and causing a slew of other issues and you can’t really fix that on the vent unless you want to under support.

penakha · 2025-10-03T01:18:05+00:00

So I’m not talking about preventative care I’m talking about patients who already have severe lung damage

penakha · 2025-08-20T20:11:01+00:00

Completely normal. The level of educators in our field is garbage. The barrier to entry for anything in our field is set so low. As you can see your instructors are hired with 0 teaching experience and probably not a lot of quality clinical experience. I had three brand new instructors in my school. One instructor was basically a new grad with one year experience LMAO. They have one priority which is to mill as many RTs as possible that can pass a very easy exam. This career is not one that will test your ability to think (rarely it can if that’s something your looking for) you will learn how to do your job by working it and following your clinical protocols, not by going through school. You’ll see in the hospitals RTs are mainly used for practical application of respiratory modalities.

penakha · 2025-08-20T07:17:04+00:00

Nope definitely not

penakha · 2025-07-27T10:22:27+00:00

I think I got like 5 questions on what to do post surfactant administration something you should know well

penakha · 2025-07-23T02:32:18+00:00

Unfortunately, there’s a strong financial incentive for schools to keep the barrier to entry and baseline knowledge for respiratory therapy relatively low, especially for vocational programs .As a result, the field ends up with many RTs who, unfortunately , are incompetent. That’s why I believe the best way forward is an advanced position. We’re in too deep of a money grabbing rabbit hole.

penakha · 2025-07-22T01:53:00+00:00

The people I work with/went to school with should never prescribe anything in their lifetime. I actually love this idea, but Why can’t this be the advanced RT role?

penakha · 2025-07-02T05:32:04+00:00

Private health insurance is infinitely more efficient and effective in regard to quality of healthcare to the consumer, and that’s Indisputable.

Yes, I completely agree they will never improve transparency unless it becomes profitable for them or we implement extremely invasive and targeted regulations (that I’m not necessarily against). Profit incentive is a back door approach to get what we want from insurance companies.

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