Critical Decisions

To obtain credit, please read the entire module and follow the instructions at the end. All tests can be taken online at www.saxetesting.com/cd for immediate credit.

Critical Decisions: Enhancing patient-specific care
in the critically ill

Interest in measurement of respiratory gas exchange has increased tremendously during the past decade. Clinicians and scientists in various fields of medicine have seen the potential of accurate measurement of carbon dioxide production and oxygen consumption as a valuable tool for diagnostic and therapeutic purposes. Clinical applications vary from assessment of energy requirements and responses in nutrition to comprehensive analysis of ventilation and oxygen transport in intensive care patients with complex respiratory and hemodynamic problems. This education site is dedicated to providing clinicians with the necessary physiological, clinical and technical information to better understand gas exchange measurements in the critically ill ventilated patient. A better understanding of gas exchanges can potentially lead to better outcomes through improved nutritional support and the avoidance of ventilator-induced injury. Each module in this series is accredited for continuing education.
Current Module

Functional Residual Capacity (FRC) is a measurement of the reservoir of air that keeps lungs oxygenated after a normal exhalation. In mechanically ventilated patients, FRC measures actual lung volume. Although FRC is a vital indicator of acute lung pathology, until recently, FRC could not be measured directly—only estimated through indirect methods. Today's technological advances that enable direct measurement should eliminate the barriers that previously existed in routinely using this parameter in clinical decision-making. Serial FRC measurements provide valuable information regarding disease progression/resolution, optimization of PEEP, and prevention of ventilator-induced lung injury. Clinicians need to be aware that many factors besides disease pathology affect FRC, including prone positioning, recruitment maneuvers, suctioning, and weaning. Direct FRC monitoring is an underutilized tool that can help manage many ventilated patients with developing or resolving acute respiratory illnesses.

Monitoring FRC in Ventilated Patients
Alexander Adams RRT, MPH, FAARC

Panel Discussion:
The Utility of Functional Residual Capacity

Moderator: John Marini, MD

 
Provided by an educational grant from GE Healthcare