The Advanced Ventilator Book Quotes

“A transient hemodynamic improvement is often seen when a bolus of sodium bicarbonate (e.g., an "amp") is given, but this is more likely due to the loading of sodium than the change in pH—similar effects are seen with bolus dosing of hypertonic saline. Keep in mind that the NaHCO3 given in a 50 mL ampule is 8.4%, which is a very hypertonic sodium solution.”
― William Owens, The Advanced Ventilator Book

“In the ARMA study and subsequent ARDS Network studies, administration of buffering fluids was permitted to keep the pH ≥ 7.15. Sodium bicarbonate (NaHCO3) is often used to treat acidemia, but it does have several drawbacks. Under usual conditions, the bicarbonate anion is converted to CO2 and H2O via carbonic anhydrase:”
― William Owens, The Advanced Ventilator Book

“In patients with status asthmaticus, using lower tidal volumes and respiratory rates prevents dynamic hyperinflation, pneumothorax, and pneumomediastinum, even though it may lead to a respiratory acidosis. Permissive hypercapnia is considered acceptable because the benefits of avoiding lung injury are considered far more important than achieving "normal" alveolar ventilation.”
― William Owens, The Advanced Ventilator Book

“The ARMA study demonstrated a reduction in mortality in patients with ARDS when tidal volumes of 4-6 mL/kg PBW were used, compared with tidal volumes of 12 mL/kg.3 This benefit was seen despite worsening gas exchange in the low tidal volume group.”
― William Owens, The Advanced Ventilator Book

“1.​The SaO2 is what matters, not the PaO2. 2.​An increase in cardiac output can offset hypoxemia. 3.​The SvO2 is low in low-flow states 4.​The DO2:VO2 ratio, SvO2, and O2ER reflect the balance between delivery and consumption. They don't represent a specific target for intervention. 5.​SaO2, SvO2, O2ER, and lactate are all pieces of information and not goals in themselves. They must be taken into account along with urine output, peripheral perfusion, mentation, and other clinical information before any treatment decisions can be made. 6.​Give the patient just as much oxygen as he needs. This may be less than you think.”
― William Owens, The Advanced Ventilator Book

“Thus, lactate should be viewed as a nonspecific marker of physiologic stress.”
― William Owens, The Advanced Ventilator Book