Advertise on podcast: The Peak Inspiration Podcast

Former ICU nurse and palliative care APP Courtnee Stagner shares the words clinicians can use to help families face what’s happening, understand their options, and make decisions grounded in what the patient would want. An honest, practical conversation about ICU care, palliative care, and saying the hard things with compassion.

Everyone thinks ventilator waveforms are confusing, but when you understand the physiology you can dissect them much easier!!! In this lecutre, I go over core concepts in ventilator waveform physiology : 💨 Flow occurs when there’s a pressure gradient.📈 Know what normal looks like → recognize when the patient–ventilator interaction changes.🧠 Waveforms show you how pressure, flow, and volume are interacting in real time. This is a shortened version of the whole lecture which could be found on my patreon along with the slides at https://patreon.com/Pulmtoilet?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink Click below for a free month ! Attendings Critical Access CRNA APPs, PharmD, and Rehab Services Medics/RNs/RTs/Flight Crew All Trainees & First Responders

In this episode, we move beyond normal waveforms and break down the abnormal patterns you’ll actually encounter at the bedside. Learn how changes in pressure, flow, and volume can reveal problems with resistance, compliance, flow delivery, air trapping--lets move beyond just sedating!! Full video and powerpoint on patreon! Click your job below for a free month! Attendings Critical Access CRNA APPs, PharmD, and Rehab Services Medics/RNs/RTs/Flight Crew All Trainees & First Responders

🫁 MAKE THE DRIVING PRESSURE 15 We all hear it: “Keep driving pressure 15.” Cool… HOW? There’s no driving pressure button on the ventilator. In this webinar, we break down the physiology and the practical bedside approach to actually lowering driving pressure—using tidal volume, PEEP, recruitment, compliance, ventilator modes, and waveform interpretation. The goal isn’t just to memorize DP 15. It’s to understand WHY the driving pressure is high and what you can actually do about it. 🎥 Full webinar + slides available on Patreon: Patreon.com/cw/Pulmtoilet Click the link for your specialty to sign up and get a free month!!!!! Attending CRNA APPs/PharmD/Rehab Services RTs/RNs/Medics/Flight All Trainees and First Responders Critical access healthcare workers

I go over 4 waveforms sent to me from followers! They quite bad so take a listen and let me know what you think! Only 2/4 are here-- go to my patreon (@pulmtoilet) for the full 4 waveforms and the accompanying PDF to download and annoate along! https://www.patreon.com/Pulmtoilet/posts/waveform-video-2-167832507?utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=postshare_creator&utm_content=join_link

Bridging the Gap in Critical Care Education In this episode, I sit down with Karen Battistoni, a CVICU educator from the Texas Medical Center, to discuss one of the biggest challenges in critical care: the gap between classroom education and bedside practice. We explore why many clinicians feel underprepared for complex ICU patients, how social media has become a powerful educational tool, and why teaching practical physiology matters. Karen also shares her perspective on fast-track cardiac surgery protocols, emphasizing that patient assessment and clinical judgment should always come before rigid protocol adherence. Finally, we discuss the importance of collaboration between nurses, respiratory therapists, and physicians, and how shared decision-making leads to better patient outcomes. Key takeaways: Practical education is essential for building ICU confidence. Protocols should support—not replace—clinical judgment. Teamwork is critical for delivering high-quality patient care. Whether you're a nurse, RT, APP, resident, fellow, or attending, this conversation offers practical insights you can apply at the bedside.

In this episode, I break down the same framework I teach in my Ventilator Dyssynchrony Bootcamp. Rather than memorizing a long list of named dyssynchronies, I focus on understanding what a normal breath should look like first. From there, we compare expectation to reality and systematically work through each phase of the breath—trigger, flow, cycle, and expiration—to identify where the patient and ventilator have fallen out of sync. This approach helps make waveform interpretation more intuitive, more reproducible, and ultimately more useful at the bedside for anyone caring for mechanically ventilated patients!

A clip of my webinar that I did on PRVC and why adaptive modes are generally bad in the ICU. Want full webinar? Email ME! [email protected]

Running back my talk from ResusX about ventilating severe acidosis! I try to approach this from a pragmatic perspective! Nothing will work great so just do the least bad thing!!

We all know SIMV sucks, but what exactly is the difference between SIMV and AC?

My thoughts on a waveform question from April 17 on my Instagram @pulmtoilet !!! Go check it out !

In this episode of Peak Inspiration, we’re bringing you a high-yield excerpt from the Pressure Control Part 2 webinar, focused on one of the most practical skills in mechanical ventilation—recognizing abnormal waveforms. We break down how to interpret pressure, flow, and volume waveforms through the lens of the equation of motion, helping you pinpoint whether the issue lies in resistance, compliance, or patient effort. Instead of memorizing patterns, this episode teaches you how to think through the waveform so you can quickly identify what’s wrong at the bedside. If you’ve ever looked at a ventilator and felt like something was off but couldn’t quite explain why, this episode will sharpen that instinct and give you a framework you can apply immediately.

When the ventilator triggers a breath the patient didn't ask for, something has gone wrong. In this episode we dig into autotrigger: why it happens, how to spot it at the bedside, and the cascade of harm it can set off when it goes unrecognized. Then we turn to one of the most underused numbers on the ventilator screen: the airway occlusion pressure (P0.1). This 100-millisecond window into the respiratory drive tells you things that tidal volume and respiratory rate simply can't — how hard the brainstem is working before flow has even begun. We break down the physiology behind it, walk through how to measure and interpret it, and explore how P0.1 can serve as both a trigger-sensitivity troubleshooting tool and a real-time gauge of patient effort and diaphragm load. Along the way we tackle practical questions: what P0.1 thresholds should raise concern, how autotrigger and elevated drive interact with patient-ventilator asynchrony, and when you should let the number change your clinical decisions. Whether you're a fellow just getting comfortable with modes and waveforms or an experienced intensivist looking for a sharper framework, this episode gives you a cleaner mental model for one of ventilation's trickier corners.

Intro to mechanical ventilation is out now. This is a true starting point. No fluff, no overcomplication just the fundamentals you actually need when you’re at the bedside making decisions. We break downWhat each ventilator setting actually doesHow to choose initial settings without guessingVolume vs pressure modes in a way that finally clicksHow to recognize when things are going wrong early You can find the full episode for FREE on YouTube, Spotify, and Apple Podcasts Search “The Peak Inspiration” or find it through @pulmtoilet If you watch or listen, I’d genuinely like to hear what you think.What made sense, what didn’t, and what you want covered next.

Sepsis care keeps evolving but not always in ways that feel clean or universally agreed upon. In this episode, I break down the latest Surviving Sepsis Campaign guidelines what actually changed, what didn’t, and what matters at the bedside when the patient in front of you is crashing. We focus on two of the most debated areas right now: Prehospital antibiotics: Are we truly helping patients or just moving the needle earlier without improving outcomesBlood cultures before antibiotics: Dogma vs reality when time, access, and patient stability are working against youThis isn’t a guideline summary. It’s a practical discussion about where the evidence is strong, where it’s weak, and where clinicians are still forced to make judgment calls in real time. If you’ve ever wondered whether you’re practicing evidence-based medicine or just following momentum, this episode is for you.