The Peak Inspiration Podcast

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 down
What each ventilator setting actually does
How to choose initial settings without guessing
Volume vs pressure modes in a way that finally clicks
How 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 outcomes
Blood cultures before antibiotics: Dogma vs reality when time, access, and patient stability are working against you
This 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.

My approach to ventilating severe metabolic acidosis! Often needing to balance harm of the acidosis with harm of the ventilator and creating a balance of these 2 forces while we fix the underlying pathophysiology!

Spontaneous Breathing Trials aren’t just a checkbox before extubation.
They’re one of the most nuanced and most misunderstood checklists in critical care.
In this episode, we unpack why SBTs are not simply “pass or fail.”
A patient can “pass” the numbers and still fail at the bedside. They can “fail” and still be extubatable.
We dive into:
• Why the RSBI isn’t about extubatability
• How anxiety, pain, sedation washout, and cardiac function distort the data
• The hidden hemodynamics of liberation
• Why diaphragm performance matters more than a single respiratory rate
• And how over-reliance on protocol can blind us to physiology

Because at the end of the day, extubation is not decided by a spreadsheet. It’s decided at the bedside.
By watching the patient. By reading subtle cues. By integrating ventilator data with work of breathing, mental status, secretion burden, airway protection, and trajectory.
SBTs are a test of physiology — but they’re also a test of clinical judgment.
Dont fall into the trap of : "better luck tomorrow"
#floatingventguy
IG: @pulmtoilet

If your PEEP strategy is:
“ARDSnet table + hope for the best”
…it’s time for an upgrade.
This webinar walks through how to personalize PEEP in ARDS using compliance, stress index, PV curves, and bedside clues you can use on your next shift.

#floatingventguy