We are podcasting today directly from ATS 2025 in San Francisco! Every year, in collaboration with the ATS Critical Care Assembly, we highlight some of the scientific symposium programming from the conference. Today, Furf and Monty sit down with the … Continue reading
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(00:20):
Good morning, everyone, and welcome back to Palm
Peeps. We're joining you live today from ATS
2025
in San Francisco.
And while I love all of our episodes,
I really love the live episodes when I
get to sit directly next to you first.
So excited to see you in person and
be doing this episode together. Yeah. These are
truly the few highlights of my year because
we get to hang out in person together.
(00:41):
We spend a lot of time on Zoom
and audio recorded together. So it's always great
to get to chill and be in the
same room. And then I also love these
episodes because we're always doing some real podcasting.
So right now, we're tucked away in a
conference room. Nobody really knows we're here. I
think we've done some from, the lobby of
a hotel, but great that we'll still be
able to get an episode out. Yeah. And
for the past few years, we've been podcasting
(01:02):
advance of ATS
direct from ATS as well as after ATS
for follow-up. And this year, we're excited to
continue the tradition. So in partnership with the
ATS Critical Care Assembly, we're highlighting some critical
care symposiums.
And today, we're joined by the symposium chairs
for a session entitled mechanical ventilation of the
future, new foundations for ventilator strategies.
(01:22):
Yeah. And we're talking this is Sunday morning
that we're recording. It's gonna come out an
hour after we record this, and the session
is tomorrow, Monday. So, hopefully, you get to
hear this, and then it'll pique your interest
and you'll attend the session. I think this
is such an important topic. It's one of
the ones I marked down immediately, you know,
mechanical ventilation being so core to what we
do, and I think there are a lot
of novel things to hear about. And then
finally, this is part of the critical care
(01:44):
track, and you can get CME for this.
So if you're looking for how to get
some continuing medical education credits, this is a
great talk for you.
Exactly. I'm so excited to be joined today
by three amazing guests. And, again, appreciate your
time on this Sunday morning before the conference.
We know how busy you are. But first,
I'd like to introduce a returning guest to
the show. We're thrilled to welcome back doctor
(02:04):
Juliana Vajeda, who's an associate professor at the
University of Sao Paulo, Brazil, where she's also
co director of the pulmonary and critical care
fellowship program.
She's an MD, PhD, and a physician scientist
with specific interest in mechanical ventilation as well
as medical education.
And finally, as one of her other roles,
Julian also serves as ATS Mecor Latin America
(02:25):
director and does a fantastic job with that.
So glad to have you joining us back
on the show today, Julian. Thank you so
much for inviting me. I'm really happy to
be here. I'm a fan of the show,
and, thanks for having us.
Yeah. It's our pleasure. Next, we wanna welcome
doctor Bhakti Patel. Bhakti is an assistant professor
of medicine at the University of Chicago. She's
a dedicated researcher and educator,
(02:46):
and her research focuses primarily on noninvasive ventilator
support. Welcome to Pollen Beeps. Thanks for having
me. I'm excited to join for the first
time today.
Hey. We have another, as you said, another
newbie joining us to the show, but who
says he's an avid listener, but excited to
welcome doctor Akhram Akhreb Khan. Akhreb's associate professor
of medicine at Oregon Health and Science University.
(03:06):
He's a pulmonary critical care and sleep provider
with specific clinical interest in critical illness, pulmonary
vascular disease, as well as sleep apnea.
Additionally, he's an accomplished translational science researcher. Such
an honor to have you joining us today
on pulp beams. Thanks for inviting me. It's
a great pleasure to be here. I've listened
to you guys on my drive all the
time. You have a great show.
Thank you so much. We appreciate it. Just
(03:28):
as a quick disclaimer for everyone listening, as
a reminder, this podcast is not meant to
be used for specific medical advice, and the
views we expressed today do not necessarily reflect
those opinions or policies of our respective employers
or of the ATS.
Thanks, Firth. And I'd love to get us
started today with our first question.
And, Juliana, I'd love if you could tell
us why the three of you thought this
was an important topic to bring to this
(03:49):
year's annual conference.
I guess we're all passionate about mechanical ventilation.
Becky was actually the driver in this initiative,
so she talked to everybody, started the submission.
But I guess the main
driver is we love mechanical ventilation, and we
felt there were gaps that we could address
with the session.
Yeah. Totally. You're right. So we all love
(04:11):
thinking about it and doing it. So it's
a bedrock of pulmonary and critical care, both
practice, education, and I think a huge part
of research as well. And we all start
learning about it as medical students, but it's,
like, constantly evolving due to new research initiatives
and technological developments. Bhakti, what should attendees of
this session expect to learn about and take
away from the session?
(04:31):
We wanted to highlight some emerging concepts in
the management of mechanical ventilation so that attendees
would get familiar with how they might impact
clinical care. Specifically, we wanted to go beyond
just the initial settings of tidal volume and
think more about how do we adjust the
ventilator to approach the patient's risk free effort
or preserve the diaphragm,
maybe even think about their neural drive and
(04:53):
how to improve their vent patient ventilator interactions.
So this session will really introduce a lot
of new tools in your armamentarium
as you customize the ventilator
experience for our patients. Yeah. That sounds fantastic.
I'm really looking forward to hearing about it.
And you have so many great speakers and
topics in this session. We wanna hear some
more specifics about them. But one thing that
really stood out to me was that you're
(05:13):
starting out the session by hearing a patient
story, which I think is really interesting. Barkha,
can you tell us a little bit about
this and why you decided to have a
patient come share their perspective? I think it's
important for us to understand the lived experience
of our patients
so that
we keep our patients front and center. And
not only are we looking at the physiology,
(05:35):
but we are also looking at
long term outcomes for our patient and be
able to return them to their life, back
to their community, their families.
And so it's important to hear from patients
what they feel,
hear, and see
in the ICU and how
mechanical ventilation has affected them so that we
can be better physicians and providers.
(05:57):
And I really love that component. And, really,
the three of y'all, thank you for bringing
that in because I think it is so
great for attendees to be able to hear
directly from a patient. Abraham, as you said,
I think patients are the best teacher. So
it's so great to to see that and
understand that physiology that's happening at the bedside.
And I wanted to switch a little bit
more now, though. Right? Because so great and
so many things that you could probably cover,
(06:18):
Bhakti. Such a huge range of topics to
consider when thinking about noninvasive as well as
invasive mechanical ventilation.
Can you tell us a little bit about
how the topics you've got to include in
the session and why you decided to focus
on them? Yeah. We chose to cover topics
that are the big unknown, controversial in the
management of respiratory failure, namely when should you
use a noninvasive
(06:39):
approach and when should you say that it's
failing? How do you set the ventilator initially,
but how do you titrate it to people's
efforts so that you don't cause lung injury?
And then how do you think about protecting
the diaphragm? I think these are all concepts
that are emerging in physiologic literature, but are
going to be soon tested in clinical trials.
In addition, we really adapt Beneliter strategies that
(07:01):
have been studied in ARDS to everyone without
ARDS, and so maybe we need to think
a little bit more broadly about customization of
our strategies.
So we tried to be broad because I
think a lot of these concepts are gonna
come up in new clinical trials, and it's
important to at least understand the breadth of
the unknowns within this literature space.
Oh, that's really well said because I feel
like there are so many times when you're
(07:23):
in the unit or you're thinking about the
ventilator or you're coming to look at it,
and there are two questions. One, what's going
on? What could I do be doing better?
And then often the harder one is, oh,
I recognize there's some new synchrony or there's
some effort, but how do I actually fix
that in a evidence based way? Even just
starting with the awareness, I feel is a
really important one. The speaker list for this
session is like a who's who of the
leaders in the fields of mechanical ventilation and
(07:45):
ARDS. And so all most, if not all
of them have major research initiatives going on.
Some of which we've probably heard about, some
not yet, some trials that I think people
are recruiting. Juliana was hoping you could tell
us about if there are any specific projects
or studies that you're looking forward to hearing
about at the session.
I was really curious to see if the
speakers involved in the practical adaptive platform coming
(08:05):
from the Canadian Critical Care Trials Group
will present any preliminary data. I'd I'm really
excited about the project and the way they're
looking into
many, if not all, aspects of mechanical ventilation,
and, hopefully, they will have something fresh for
us. Yeah. We'll keep our fingers crossed for
that one. That is also one that is
the high above my list. Thank you so
(08:27):
much.
A question that I think often comes up
in this conference is that we hear about
a lot of groundbreaking
research,
But how do we take some of those
either preliminary findings or new findings and then
actually bring them to the bedside to our
practice? How do they influence the way that
we're teaching trainees or taking care of patients?
So I know at these sessions, we're gonna
(08:47):
hear some enlightening findings and initiatives. And Akra,
I was wondering in your experience how you've
had sessions like this influence your day to
day practice.
I think these sessions are very important. And
just in the last couple of ETS and
CHEST conferences, I attended some sessions on ventilator
waveforms.
I attended sessions on using esophageal manometry
(09:08):
in adjusting PEEP. And then I was able
to bring that back to my ICU. And
what I'm hoping is that Serena is going
to talk about in her session how to
use driving pressure and
how that can effectively help us adjust PEEP.
And maybe
I'll start using that more often than esophageal
balloons
that I have to put in myself each
(09:28):
time. Yeah. You're good. Yes. Certainly, Drive USA
has some preliminary data that I will be
back with another another episode about
it. And I think I was actually in
a fellows course yesterday, and the question got
bounced to the fellows, like, how many people
put esophageal balloons in your centers? And I
will say it's a it's half and half.
So I do love this aspect where there's
different institutional practices, but there's so much that
(09:50):
we can always learn from each other and
then what we can take back and use
at our home institutions.
And as the three of you moderating the
session, I'm sure that you're very excited to
hear from all of the speakers, all of
the topics that you have programmed so far.
But I'm interested to know if there is
one general topic or specific talk that you
are looking forward to the most for the
session. Juliana, I'll start with you. Yeah. Sure.
(10:12):
I love all the topics, but I guess,
really curious to hear Peter Sautilo talk about
the synchronies and how we can incorporate
this knowledge into how we take care of
patients and how clinical trials we're looking to,
if we can if fixing
synchronies, for example, will have an impact in
patient outcome. So that's interesting for me.
(10:33):
Awesome. Akra, what about you? We always focus
more on ARDS in the ICU, and we're
always doing talks on it. I was interested
in looking at what Kevin has to say
on all of our non ARDS patients, which
are, like, ninety percent of our patients in
the ICU. I think that session is very
important
As is the p PCE session on patient
(10:55):
self induced lung injury that we are only
now starting to figure out how best to
manage since we are also managing a lot
of our patients on noninvasive,
high flow nasal cannula. So I wanna listen
to those guys and see what they have
to tell us.
So great. Such great topic so far. But,
Bogdan, we'd love to hear from you if
you'd have a a favorite topic you're most
(11:15):
interested to hear. Yeah. I'm interested in Irene
Tellius's
talk on patient effort. I feel like patient
effort is this Goldilocks phenomenon where too much
is bad for the lungs, too little is
bad for the diaphragm. So I'd like to
learn a little bit more from her about
how to feasibly measure effort and that one
a way that is practical, but then also
somewhat accurate to the gold standard and what
(11:37):
you would do about it once you see
it. I think that would be a really
cool talk.
Yeah. I'm excited for that one as well.
I feel like I often have a respiratory
therapist or a trainee starting to talk about
p zero one, and and then I'm looking
at the patient. I'm like, they look pretty
comfortable. I understand that number is a little
different than we expect for it, but maybe
I'm thinking about it wrong. And I'll be
very interested to hear what they have to
(11:57):
say. It's gonna be a great session. I'm
really looking forward to it. I actually think
I was supposed to be live tweeting it
for ETS, so I'll be there. And if
I'm looking down, they'll hold against me. Juliana,
can you remind our listeners where it is,
if they have to do anything to sign
up beforehand, or if they can just pop
by? Sure. The session is happening from 02:15
to 03:45PM
on Monday, May 19 In the West Building,
(12:19):
Level 3 most consented rooms,
3 4 G
oh, sorry. 3014,
30 16, and 3018. And you don't need
to sign up. And if you're using the
app, you can just look for b 82
session and add it to your app, to
your agenda, and then that's easier to find
the rooms.
That's great. I feel like I added it
to my calendar earlier today, so definitely excited
(12:41):
for that. And for those that for those
attending ATS that may not be able to
make the session if they have a conflict
or for those listening today that maybe weren't
able to join ATS twenty twenty five, are
there other resources out there that you would
recommend for learning about ventilators more in general
and more importantly for staying up to date
on the latest innovations in this topic? Bambi,
I'll ask I'll start with you. Yeah. The
(13:03):
Blue Journal actually routinely puts out reviews on
how to interpret esophageal manometry,
how to look at p zero point one.
And a lot of these reviews are actually
written by our speakers today. So if you
just look them up in Blue Journal, there's
a lot of clinical perspective pieces that they've
written.
Perfect. Thank you. Juliana?
Yeah. I love the ATS scholar videos on
(13:24):
my clinical ventilation. I think they're really helpful.
And also,
they're on demand access to the conference sessions.
So if people are not here, but they
can still
access these sessions later throughout the year, which
I think is great for people who didn't
come for several reasons.
Thank you. That's such a great resource. And
I think that how I teach, I know
that you have a great one on liberating
(13:44):
from mechanical ventilation, which I use and I
tell all my trainees about. So So that's
a great resource and but let Ofram, anything
else that you wanna share? Make a second
plug for the on demand course. I put
it on my iPad and work out,
and it's great. The other thing is that
both ATS as well as Chest have mechanical
ventilation courses that people can take, especially for
(14:05):
trainees,
that are very helpful. But on demand for
the conference is very helpful.
Yeah. It's definitely a great plug. It's so
hard to teach about ventilators without seeing and
watching it. And so happy and able to
have that there and then scroll back and
forth is really helpful.
Alright. For our last content question of the
day, I'm gonna go a little bit more
abstract. I sometimes can't just help myself when
(14:26):
we have three such smart people in a
room to talk about. So your session is
entitled, very captivatingly,
mechanical ventilation of the future.
So in your career so far, how much
has the practice of mechanical ventilation changed, and
where how different do you think it's gonna
look when we're doing another episode at ATS
twenty thirty five or 2045?
What I would say is when we started
(14:47):
out, we were looking at oxygenation and delivering
our tidal volume. That was a long time
back. Now we are trying to do more
personalization
for people,
individualizing
based on effort,
doing low tidal volumes.
In the future, what I'm hoping is that
we'll be able to use artificial intelligence to
reduce closed loop systems
that will change the ventilator settings
(15:10):
as the patient physiology changes.
So as the lung compliance changes, we the
ventilator automatically
changes the tidal volume,
and we have these systems that self adjust.
But what I'm really hoping is that we'll
still maintain our presence
in the center of it all so that
(15:30):
we are there to provide guidance and not
just blindly dependent on the AI to do
everything for us.
Yeah. Hopefully, we're not all out of a
job by 2018. That's 2035. No. But I
I do think as these systems are evolving
for us to understand what they're looking at
and doing, we already use one adaptive mode
quite a bit at my hospital. And there
are some people who don't have any understanding
(15:52):
of what it's doing, and it never alarms.
And so you have to be able to
look at it and adjust it and and
know what to look at in those modes.
That's a great point. Exactly.
Yeah.
Yeah. I think in the beginning of my
training, it was all about protect the lung
first,
and everything else doesn't matter. But there's complications
of diaphragm injury that are shared with ventilator
in injury. So I'm actually interested in seeing
(16:15):
what comes out in terms of methods and
strategies that can protect the lung and the
diaphragm and maybe lead to less distal organ
injury. So I hope in the next ten
years, we'll be talking about that.
That's great.
I guess well, I agree with that been
what has been said. I I guess, what
I would like to see in the future
is that we're able we come up with
(16:37):
strategies to
teach people how to use mechanical ventilation, that
it's more
it's more disseminated that clinicians, not only pulmonary
and physical care physicians, are comfortable with dealing
with mechanical ventilation, possibly with the support of
AI, but also that they know what they're
doing. So I guess what I would like
to see is that educational mechanical ventilation is
(17:00):
stronger in across the world.
Yeah. I love that. Looking forward, as you
said, '20 ATS 2035.
We're we'll all be together doing another episode,
I'm sure.
But, Damon, I really wanna thank the three
of you for coming on the show today.
We know it's true how busy you are
at conferences, so thank you for taking the
time early this Sunday morning to to come
on. As one final question for today, I
(17:21):
wanna ask the three of you your advice
to listeners about getting a session program at
ATS. The deadline to submit sessions comes extremely
rapidly, so people are gonna start preparing for
ATS twenty twenty six in just the coming
weeks. Can you tell listeners today how did
you all come to pick a topic and
gather as a group of chairs to submit
such a fantastic proposal?
I would say pick a topic you're passionate
(17:41):
about, and then that has gaps that you
wanna address. I think that's the main thing.
Yeah. I think go around the conference today
and then think, man, I wish they would
actually talk about this.
And that probably is hitting a nerve for
a lot of people and lean into controversy.
And then tap the people who are on
(18:01):
the cutting edge to try to answer that
burning question. I think those sorts of sessions
tend to be the most popular when you
submit them.
I think it's important to find also besides
what Huyana and Bakti have said is find
a team with diverse perspectives. Get a catchy
title that is controversial
that will irritate some people, and they will
show up.
And, also, get help from the assemblies. Your
(18:24):
assemblies are here to help you find a
mentor who has submitted the session before. They
can guide you. The assembly
chairs, the assembly members can guide you, and
go with it. Yeah. That's great advice. Yeah.
I think all of that is great. I'm
on one of the programming committees. And I
do think like this session and a couple
other sessions
were in response to some feedback from the
year before. There wasn't a lot of raw
(18:46):
critical care, raw mechanical ventilators. And now I'm
thrilled that there is for this session. And
then I will just also make a plug
to everyone listening.
It's
often the same names putting in proposals.
If you're a trainee or a young attending
and you have an idea, like, this is
a perfect opportunity to approach other people in
your field that you haven't worked with and
say, I will take the bulk of, like,
putting a little writing and coordination together, and
(19:07):
then we could submit a proposal together. And
highly encourage you to do that. ATS is
always looking for people to do I love
a good collaboration. Yeah. And and senior researchers
are always busy, and they love the help
from junior faculty,
fellows, trainees to bring things forward. Yeah. Absolutely.
Thank you all so much for taking the
time to come on the show. We really
appreciate it. Indeed, we have 25 more meetings
(19:28):
together today, so we'll keep banging out. And
thank you all for tuning and listening, and
we hope if you're at ATS, you'll get
to enjoy this session. This episode was written,
produced, edited by myself and Christina Montemayor.
Music's original music by Eric Rogers, and we'll
see you next.
Good morning, everyone, and welcome back to Palm
Peeps. We're joining you live today from ATS
2025
in San Francisco.
And while I love all of our episodes,
I really love the live episodes when I
get to sit directly next to you first.
So excited to see you in person and
be doing this episode together. Yeah. These are
truly the few highlights of my year because
we get to hang out in person together.
(00:41):
We spend a lot of time on Zoom
and audio recorded together. So it's always great
to get to chill and be in the
same room. And then I also love these
episodes because we're always doing some real podcasting.
So right now, we're tucked away in a
conference room. Nobody really knows we're here. I
think we've done some from, the lobby of
a hotel, but great that we'll still be
able to get an episode out. Yeah. And
for the past few years, we've been podcasting
(01:02):
advance of ATS
direct from ATS as well as after ATS
for follow-up. And this year, we're excited to
continue the tradition. So in partnership with the
ATS Critical Care Assembly, we're highlighting some critical
care symposiums.
And today, we're joined by the symposium chairs
for a session entitled mechanical ventilation of the
future, new foundations for ventilator strategies.
(01:22):
Yeah. And we're talking this is Sunday morning
that we're recording. It's gonna come out an
hour after we record this, and the session
is tomorrow, Monday. So, hopefully, you get to
hear this, and then it'll pique your interest
and you'll attend the session. I think this
is such an important topic. It's one of
the ones I marked down immediately, you know,
mechanical ventilation being so core to what we
do, and I think there are a lot
of novel things to hear about. And then
finally, this is part of the critical care
(01:44):
track, and you can get CME for this.
So if you're looking for how to get
some continuing medical education credits, this is a
great talk for you.
Exactly. I'm so excited to be joined today
by three amazing guests. And, again, appreciate your
time on this Sunday morning before the conference.
We know how busy you are. But first,
I'd like to introduce a returning guest to
the show. We're thrilled to welcome back doctor
(02:04):
Juliana Vajeda, who's an associate professor at the
University of Sao Paulo, Brazil, where she's also
co director of the pulmonary and critical care
fellowship program.
She's an MD, PhD, and a physician scientist
with specific interest in mechanical ventilation as well
as medical education.
And finally, as one of her other roles,
Julian also serves as ATS Mecor Latin America
(02:25):
director and does a fantastic job with that.
So glad to have you joining us back
on the show today, Julian. Thank you so
much for inviting me. I'm really happy to
be here. I'm a fan of the show,
and, thanks for having us.
Yeah. It's our pleasure. Next, we wanna welcome
doctor Bhakti Patel. Bhakti is an assistant professor
of medicine at the University of Chicago. She's
a dedicated researcher and educator,
(02:46):
and her research focuses primarily on noninvasive ventilator
support. Welcome to Pollen Beeps. Thanks for having
me. I'm excited to join for the first
time today.
Hey. We have another, as you said, another
newbie joining us to the show, but who
says he's an avid listener, but excited to
welcome doctor Akhram Akhreb Khan. Akhreb's associate professor
of medicine at Oregon Health and Science University.
(03:06):
He's a pulmonary critical care and sleep provider
with specific clinical interest in critical illness, pulmonary
vascular disease, as well as sleep apnea.
Additionally, he's an accomplished translational science researcher. Such
an honor to have you joining us today
on pulp beams. Thanks for inviting me. It's
a great pleasure to be here. I've listened
to you guys on my drive all the
time. You have a great show.
Thank you so much. We appreciate it. Just
(03:28):
as a quick disclaimer for everyone listening, as
a reminder, this podcast is not meant to
be used for specific medical advice, and the
views we expressed today do not necessarily reflect
those opinions or policies of our respective employers
or of the ATS.
Thanks, Firth. And I'd love to get us
started today with our first question.
And, Juliana, I'd love if you could tell
us why the three of you thought this
was an important topic to bring to this
(03:49):
year's annual conference.
I guess we're all passionate about mechanical ventilation.
Becky was actually the driver in this initiative,
so she talked to everybody, started the submission.
But I guess the main
driver is we love mechanical ventilation, and we
felt there were gaps that we could address
with the session.
Yeah. Totally. You're right. So we all love
(04:11):
thinking about it and doing it. So it's
a bedrock of pulmonary and critical care, both
practice, education, and I think a huge part
of research as well. And we all start
learning about it as medical students, but it's,
like, constantly evolving due to new research initiatives
and technological developments. Bhakti, what should attendees of
this session expect to learn about and take
away from the session?
(04:31):
We wanted to highlight some emerging concepts in
the management of mechanical ventilation so that attendees
would get familiar with how they might impact
clinical care. Specifically, we wanted to go beyond
just the initial settings of tidal volume and
think more about how do we adjust the
ventilator to approach the patient's risk free effort
or preserve the diaphragm,
maybe even think about their neural drive and
(04:53):
how to improve their vent patient ventilator interactions.
So this session will really introduce a lot
of new tools in your armamentarium
as you customize the ventilator
experience for our patients. Yeah. That sounds fantastic.
I'm really looking forward to hearing about it.
And you have so many great speakers and
topics in this session. We wanna hear some
more specifics about them. But one thing that
really stood out to me was that you're
(05:13):
starting out the session by hearing a patient
story, which I think is really interesting. Barkha,
can you tell us a little bit about
this and why you decided to have a
patient come share their perspective? I think it's
important for us to understand the lived experience
of our patients
so that
we keep our patients front and center. And
not only are we looking at the physiology,
(05:35):
but we are also looking at
long term outcomes for our patient and be
able to return them to their life, back
to their community, their families.
And so it's important to hear from patients
what they feel,
hear, and see
in the ICU and how
mechanical ventilation has affected them so that we
can be better physicians and providers.
(05:57):
And I really love that component. And, really,
the three of y'all, thank you for bringing
that in because I think it is so
great for attendees to be able to hear
directly from a patient. Abraham, as you said,
I think patients are the best teacher. So
it's so great to to see that and
understand that physiology that's happening at the bedside.
And I wanted to switch a little bit
more now, though. Right? Because so great and
so many things that you could probably cover,
(06:18):
Bhakti. Such a huge range of topics to
consider when thinking about noninvasive as well as
invasive mechanical ventilation.
Can you tell us a little bit about
how the topics you've got to include in
the session and why you decided to focus
on them? Yeah. We chose to cover topics
that are the big unknown, controversial in the
management of respiratory failure, namely when should you
use a noninvasive
(06:39):
approach and when should you say that it's
failing? How do you set the ventilator initially,
but how do you titrate it to people's
efforts so that you don't cause lung injury?
And then how do you think about protecting
the diaphragm? I think these are all concepts
that are emerging in physiologic literature, but are
going to be soon tested in clinical trials.
In addition, we really adapt Beneliter strategies that
(07:01):
have been studied in ARDS to everyone without
ARDS, and so maybe we need to think
a little bit more broadly about customization of
our strategies.
So we tried to be broad because I
think a lot of these concepts are gonna
come up in new clinical trials, and it's
important to at least understand the breadth of
the unknowns within this literature space.
Oh, that's really well said because I feel
like there are so many times when you're
(07:23):
in the unit or you're thinking about the
ventilator or you're coming to look at it,
and there are two questions. One, what's going
on? What could I do be doing better?
And then often the harder one is, oh,
I recognize there's some new synchrony or there's
some effort, but how do I actually fix
that in a evidence based way? Even just
starting with the awareness, I feel is a
really important one. The speaker list for this
session is like a who's who of the
leaders in the fields of mechanical ventilation and
(07:45):
ARDS. And so all most, if not all
of them have major research initiatives going on.
Some of which we've probably heard about, some
not yet, some trials that I think people
are recruiting. Juliana was hoping you could tell
us about if there are any specific projects
or studies that you're looking forward to hearing
about at the session.
I was really curious to see if the
speakers involved in the practical adaptive platform coming
(08:05):
from the Canadian Critical Care Trials Group
will present any preliminary data. I'd I'm really
excited about the project and the way they're
looking into
many, if not all, aspects of mechanical ventilation,
and, hopefully, they will have something fresh for
us. Yeah. We'll keep our fingers crossed for
that one. That is also one that is
the high above my list. Thank you so
(08:27):
much.
A question that I think often comes up
in this conference is that we hear about
a lot of groundbreaking
research,
But how do we take some of those
either preliminary findings or new findings and then
actually bring them to the bedside to our
practice? How do they influence the way that
we're teaching trainees or taking care of patients?
So I know at these sessions, we're gonna
(08:47):
hear some enlightening findings and initiatives. And Akra,
I was wondering in your experience how you've
had sessions like this influence your day to
day practice.
I think these sessions are very important. And
just in the last couple of ETS and
CHEST conferences, I attended some sessions on ventilator
waveforms.
I attended sessions on using esophageal manometry
(09:08):
in adjusting PEEP. And then I was able
to bring that back to my ICU. And
what I'm hoping is that Serena is going
to talk about in her session how to
use driving pressure and
how that can effectively help us adjust PEEP.
And maybe
I'll start using that more often than esophageal
balloons
that I have to put in myself each
(09:28):
time. Yeah. You're good. Yes. Certainly, Drive USA
has some preliminary data that I will be
back with another another episode about
it. And I think I was actually in
a fellows course yesterday, and the question got
bounced to the fellows, like, how many people
put esophageal balloons in your centers? And I
will say it's a it's half and half.
So I do love this aspect where there's
different institutional practices, but there's so much that
(09:50):
we can always learn from each other and
then what we can take back and use
at our home institutions.
And as the three of you moderating the
session, I'm sure that you're very excited to
hear from all of the speakers, all of
the topics that you have programmed so far.
But I'm interested to know if there is
one general topic or specific talk that you
are looking forward to the most for the
session. Juliana, I'll start with you. Yeah. Sure.
(10:12):
I love all the topics, but I guess,
really curious to hear Peter Sautilo talk about
the synchronies and how we can incorporate
this knowledge into how we take care of
patients and how clinical trials we're looking to,
if we can if fixing
synchronies, for example, will have an impact in
patient outcome. So that's interesting for me.
(10:33):
Awesome. Akra, what about you? We always focus
more on ARDS in the ICU, and we're
always doing talks on it. I was interested
in looking at what Kevin has to say
on all of our non ARDS patients, which
are, like, ninety percent of our patients in
the ICU. I think that session is very
important
As is the p PCE session on patient
(10:55):
self induced lung injury that we are only
now starting to figure out how best to
manage since we are also managing a lot
of our patients on noninvasive,
high flow nasal cannula. So I wanna listen
to those guys and see what they have
to tell us.
So great. Such great topic so far. But,
Bogdan, we'd love to hear from you if
you'd have a a favorite topic you're most
(11:15):
interested to hear. Yeah. I'm interested in Irene
Tellius's
talk on patient effort. I feel like patient
effort is this Goldilocks phenomenon where too much
is bad for the lungs, too little is
bad for the diaphragm. So I'd like to
learn a little bit more from her about
how to feasibly measure effort and that one
a way that is practical, but then also
somewhat accurate to the gold standard and what
(11:37):
you would do about it once you see
it. I think that would be a really
cool talk.
Yeah. I'm excited for that one as well.
I feel like I often have a respiratory
therapist or a trainee starting to talk about
p zero one, and and then I'm looking
at the patient. I'm like, they look pretty
comfortable. I understand that number is a little
different than we expect for it, but maybe
I'm thinking about it wrong. And I'll be
very interested to hear what they have to
(11:57):
say. It's gonna be a great session. I'm
really looking forward to it. I actually think
I was supposed to be live tweeting it
for ETS, so I'll be there. And if
I'm looking down, they'll hold against me. Juliana,
can you remind our listeners where it is,
if they have to do anything to sign
up beforehand, or if they can just pop
by? Sure. The session is happening from 02:15
to 03:45PM
on Monday, May 19 In the West Building,
(12:19):
Level 3 most consented rooms,
3 4 G
oh, sorry. 3014,
30 16, and 3018. And you don't need
to sign up. And if you're using the
app, you can just look for b 82
session and add it to your app, to
your agenda, and then that's easier to find
the rooms.
That's great. I feel like I added it
to my calendar earlier today, so definitely excited
(12:41):
for that. And for those that for those
attending ATS that may not be able to
make the session if they have a conflict
or for those listening today that maybe weren't
able to join ATS twenty twenty five, are
there other resources out there that you would
recommend for learning about ventilators more in general
and more importantly for staying up to date
on the latest innovations in this topic? Bambi,
I'll ask I'll start with you. Yeah. The
(13:03):
Blue Journal actually routinely puts out reviews on
how to interpret esophageal manometry,
how to look at p zero point one.
And a lot of these reviews are actually
written by our speakers today. So if you
just look them up in Blue Journal, there's
a lot of clinical perspective pieces that they've
written.
Perfect. Thank you. Juliana?
Yeah. I love the ATS scholar videos on
(13:24):
my clinical ventilation. I think they're really helpful.
And also,
they're on demand access to the conference sessions.
So if people are not here, but they
can still
access these sessions later throughout the year, which
I think is great for people who didn't
come for several reasons.
Thank you. That's such a great resource. And
I think that how I teach, I know
that you have a great one on liberating
(13:44):
from mechanical ventilation, which I use and I
tell all my trainees about. So So that's
a great resource and but let Ofram, anything
else that you wanna share? Make a second
plug for the on demand course. I put
it on my iPad and work out,
and it's great. The other thing is that
both ATS as well as Chest have mechanical
ventilation courses that people can take, especially for
(14:05):
trainees,
that are very helpful. But on demand for
the conference is very helpful.
Yeah. It's definitely a great plug. It's so
hard to teach about ventilators without seeing and
watching it. And so happy and able to
have that there and then scroll back and
forth is really helpful.
Alright. For our last content question of the
day, I'm gonna go a little bit more
abstract. I sometimes can't just help myself when
(14:26):
we have three such smart people in a
room to talk about. So your session is
entitled, very captivatingly,
mechanical ventilation of the future.
So in your career so far, how much
has the practice of mechanical ventilation changed, and
where how different do you think it's gonna
look when we're doing another episode at ATS
twenty thirty five or 2045?
What I would say is when we started
(14:47):
out, we were looking at oxygenation and delivering
our tidal volume. That was a long time
back. Now we are trying to do more
personalization
for people,
individualizing
based on effort,
doing low tidal volumes.
In the future, what I'm hoping is that
we'll be able to use artificial intelligence to
reduce closed loop systems
that will change the ventilator settings
(15:10):
as the patient physiology changes.
So as the lung compliance changes, we the
ventilator automatically
changes the tidal volume,
and we have these systems that self adjust.
But what I'm really hoping is that we'll
still maintain our presence
in the center of it all so that
(15:30):
we are there to provide guidance and not
just blindly dependent on the AI to do
everything for us.
Yeah. Hopefully, we're not all out of a
job by 2018. That's 2035. No. But I
I do think as these systems are evolving
for us to understand what they're looking at
and doing, we already use one adaptive mode
quite a bit at my hospital. And there
are some people who don't have any understanding
(15:52):
of what it's doing, and it never alarms.
And so you have to be able to
look at it and adjust it and and
know what to look at in those modes.
That's a great point. Exactly.
Yeah.
Yeah. I think in the beginning of my
training, it was all about protect the lung
first,
and everything else doesn't matter. But there's complications
of diaphragm injury that are shared with ventilator
in injury. So I'm actually interested in seeing
(16:15):
what comes out in terms of methods and
strategies that can protect the lung and the
diaphragm and maybe lead to less distal organ
injury. So I hope in the next ten
years, we'll be talking about that.
That's great.
I guess well, I agree with that been
what has been said. I I guess, what
I would like to see in the future
is that we're able we come up with
(16:37):
strategies to
teach people how to use mechanical ventilation, that
it's more
it's more disseminated that clinicians, not only pulmonary
and physical care physicians, are comfortable with dealing
with mechanical ventilation, possibly with the support of
AI, but also that they know what they're
doing. So I guess what I would like
to see is that educational mechanical ventilation is
(17:00):
stronger in across the world.
Yeah. I love that. Looking forward, as you
said, '20 ATS 2035.
We're we'll all be together doing another episode,
I'm sure.
But, Damon, I really wanna thank the three
of you for coming on the show today.
We know it's true how busy you are
at conferences, so thank you for taking the
time early this Sunday morning to to come
on. As one final question for today, I
(17:21):
wanna ask the three of you your advice
to listeners about getting a session program at
ATS. The deadline to submit sessions comes extremely
rapidly, so people are gonna start preparing for
ATS twenty twenty six in just the coming
weeks. Can you tell listeners today how did
you all come to pick a topic and
gather as a group of chairs to submit
such a fantastic proposal?
I would say pick a topic you're passionate
(17:41):
about, and then that has gaps that you
wanna address. I think that's the main thing.
Yeah. I think go around the conference today
and then think, man, I wish they would
actually talk about this.
And that probably is hitting a nerve for
a lot of people and lean into controversy.
And then tap the people who are on
(18:01):
the cutting edge to try to answer that
burning question. I think those sorts of sessions
tend to be the most popular when you
submit them.
I think it's important to find also besides
what Huyana and Bakti have said is find
a team with diverse perspectives. Get a catchy
title that is controversial
that will irritate some people, and they will
show up.
And, also, get help from the assemblies. Your
(18:24):
assemblies are here to help you find a
mentor who has submitted the session before. They
can guide you. The assembly
chairs, the assembly members can guide you, and
go with it. Yeah. That's great advice. Yeah.
I think all of that is great. I'm
on one of the programming committees. And I
do think like this session and a couple
other sessions
were in response to some feedback from the
year before. There wasn't a lot of raw
(18:46):
critical care, raw mechanical ventilators. And now I'm
thrilled that there is for this session. And
then I will just also make a plug
to everyone listening.
It's
often the same names putting in proposals.
If you're a trainee or a young attending
and you have an idea, like, this is
a perfect opportunity to approach other people in
your field that you haven't worked with and
say, I will take the bulk of, like,
putting a little writing and coordination together, and
(19:07):
then we could submit a proposal together. And
highly encourage you to do that. ATS is
always looking for people to do I love
a good collaboration. Yeah. And and senior researchers
are always busy, and they love the help
from junior faculty,
fellows, trainees to bring things forward. Yeah. Absolutely.
Thank you all so much for taking the
time to come on the show. We really
appreciate it. Indeed, we have 25 more meetings
(19:28):
together today, so we'll keep banging out. And
thank you all for tuning and listening, and
we hope if you're at ATS, you'll get
to enjoy this session. This episode was written,
produced, edited by myself and Christina Montemayor.
Music's original music by Eric Rogers, and we'll
see you next.
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