The FlightBridgeED Podcast Minute Ventilation Mastery & The Obstructive Lung Mindset – with Scott Weingart
Aug 5, 2025
Scott Weingart, a critical care and emergency medicine expert, joins the conversation to share his insights on mechanical ventilation and managing obstructive lung diseases. He challenges traditional tidal volume formulas, advocating for 8–10 mL/kg in acidosis cases. Scott breaks down the importance of context when determining minute ventilation and the role of inspiratory flow and sedation in obstructive patients. He also highlights when to avoid intubating DKA patients and clarifies misconceptions about PEEP, stressing that not all strategies are universally applicable.
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When Compensation Fails, Risk Rises
- Severe metabolic acidosis becomes dangerous when compensation fails and PaCO2 rises despite tachypnea.
- Scott Weingart prioritizes identifying patients who are no longer fully compensating as highest risk for decompensation.
Match The Clinical Context Not A Target CO2
- For patients already failing compensation, almost any reasonable ventilator will likely improve gas exchange.
- For patients with extremely low PaCO2 pre-intubation, accept you may not fully match their prior ventilation and aim for a safer PaCO2 higher than their pre-intubation value.
Start At 8 mL/kg; Use 8–10 For Acidosis
- Start most patients at 8 mL/kg tidal volume and only drop toward 6 mL/kg for true ARDS or very small 'baby lungs.'
- For transport with dangerous acidosis, use 8–10 mL/kg to prioritize correcting acidosis over theoretical lung protection.