🗝️ Key Points

• ❌ Don’t chase perfect numbers: Adequate and safe is often better than “perfect but harmful.”
• 💨 Oxygenation levers: Start with FiO₂ and PEEP, but remember MAP is the true driver.
• 🫁 Ventilation levers: Adjust RR and TV, tailored to underlying physiology.
• 🚫 Watch your obstructive patients: Sometimes less RR is more.

📝 Introduction

When you take the airway, you take the wheel and you now control the patient’s oxygenation and ventilation. In this REBEL Crit episode, Dr. Lodeserto and Dr. Acker walk through the physiology, ventilator strategies, and clinical curveballs that separate calm control from chaos at the bedside.

🗝️ Key Points

• 💨 Start with Breath Types: Controlled, assisted, and supported breaths are the foundation of all modes.
• 🛌 Comfort Over “Best Mode”: No mode improves mortality — focus on patient synchrony and comfort.
• ✅ Know the Big 5 Modes: AC: All controlled or assisted (volume or pressure). PS: Fully spontaneous, great for SBTs. PRVC: Pressure-delivered, volume-targeted hybrid. SIMV: Mixed mode, less favored in adults. VS: Spontaneous mode with adaptive pressure.
• ⚠️ Watch for Pitfalls: PRVC may under-ventilate in agitation. SIMV often causes dyssynchrony.
• 🎯 Bottom Line: Master mode mechanics and match the vent to the patient — not the other way around.

📝 Introduction

Mechanical ventilation can feel overwhelming, especially when faced with a sea of ventilator modes and unfamiliar terminology. In Part 2 of the series, we go beyond breath types and delivery mechanics to explore the most used modes in the ICU. We will break down each one; explaining how it works, when to use it, and why the goal isn’t the “best mode” but the most comfortable one for the patient.

⏰ Highlights

• 00:00 Introduction to Rebel Cast
• 00:10 Highlighting the Incrementum Conference 2026
• 00:34 Meet the Founders of Incrementum
• 01:21 The Journey to Incrementum
• 04:27 The Recognition of Emergency Medicine in Spain
• 06:04 What is Incrementum?
• 08:14 Bringing Together Top Emergency Medicine Experts
• 11:38 Exciting Sessions to Look Forward To
• 15:54 Conclusion and Invitation to Increment 2026

📝 Introduction

In this special episode of Rebel Cast, we spotlight the Incrementum Conference in Spain, a significant event in emergency medicine. Hosts welcome Dr. Francisco ‘Paco’ Campillo Palma and Dr. Carmen Maria Cano, founders of Incrementum, to discuss the recognition of emergency medicine as a specialty in Spain. They share their journey of creating the conference, emphasizing the importance of education, collaboration, and growth. The discussion also touches on this year’s conference highlights, including sessions on mental health and evidence-based medicine, and the exceptional lineup of speakers. Listeners are encouraged to attend the conference in April 2026 for an enriching experience.

📌 Bottom Line

• Join us in Spain this April for the Increment Conference!
• 👉 Register now at incrementum-conference.com

Key Points:

• 💨 Master the 3 Types of Breaths
  Control, Assist, and Spontaneous — know the difference before tackling ventilator modes.
• 📦 Breath Delivery: Volume vs. Pressure
  Volume-Targeted = fixed volume → monitor pressure
  📈 Pressure-Targeted = fixed pressure → monitor volume
• 🫁 Lung Compliance = Pressure-Volume Relationship
  Volume mode: ↑ pressure = ↓ compliance (stiff lungs)
  Pressure mode: ↓ tidal volume = ↓ compliance
• 🏋️‍♂️ Use Analogies to Simplify
  The pull-up analogy makes complex concepts easier to grasp and remember.
• 🧱 Build the Foundation First
  Before diving into complex ventilator modes, get solid on breath types, delivery methods, and lung mechanics.

Introduction:
For many medical residents, the ICU can feel like stepping into a pressure cooker. At the heart of that stress often lies one intimidating machine: the ventilator. Rather than diving headfirst into complex ventilator modes, this episode lays a critical foundation by breaking down the basic building blocks of mechanical ventilation, something every clinician should master before moving on to more advanced concepts. Once you know the 3 types of breaths and how those breaths are delivered, you can more easily understand most of the mechanical ventilator modes.

• Placing an IO in a bone with a proximal fracture, a previous IO placement attempt or any circulatory compromise proximal to the site is contraindicated
• Blood work drawn from an IO are generally not accurate, so once the patient has been resuscitated with the IO, intravenous blood draws are recommended
• Dislodgement is common; it is best to use the stabilizer that comes with the IO kit; if the kit does not have a stabilizer, stack lots of gauze on both sides of the IO needle and tape it down

• While proximal humerus site portents faster infusion rates than proximal tibia site, the main limitation of the proximal humerus site is that the arm must be held in internal rotation to avoid dislodgement of the IO
• Proximal tibia may be easier to landmark than proximal humerus
• Other sites include distal tibia, distal femur and sternum but are uncommonly employed in EDs

1. Suspect tension ptx not just in trauma but also in mechanically ventilated patients who become unstable and after central line placement
2. Confirm with US if time allows
3. Needle decompression is a suboptimal approach to decompression. Finger thoracostomy is more likely to be successful

In this episode, we will dive into a simple yet effective bedside approach to a patient in shock. By using quick physical exam findings and bedside vitals (particularly pulse pressure), you can form a quick assessment of the likely underlying etiology of a critically ill patient.

Sinus tachycardia is the most prevalent cardiac dysrhythmia in critically ill patients, yet it often receives less attention than it warrants. While the rhythm itself is not inherently dangerous, it serves as a crucial indicator of underlying physiological disturbances that require prompt evaluation and management.