what's up future resy therapist hey in this video we're going to be talking about how I time e time flow title volume minute volume restr rate total cycle time all of that stuff Etc works together you're not going to want to miss this one I promise you let's dive in all right so as I stated we're talking all about how all of these different elements of mechanical ventilation work together in this video before we dive into into that be sure to check out the respiratory coach Academy where you can find links to purchase the boot camps to help you pass the TMC and the csse as well as many um manyi courses to uh Aid you in your specific classes or maybe just brush up on some topics that maybe you feel weak in like pharmacology or maybe formulas or maybe arterial blood gases don't forget anatomy and physiology is now also on this list but most importantly from right now as soon as you watch this video watch the video first soon as you get done go enroll in the free resources class where you'll get access to a multitude of different resources that I just put out there make it available for you at no cost I will likely be posting this presentation into that course as soon as this is done so you want to be able to to to check that out and to to enroll in that the link to get here is going to be in the video description below don't miss it I promise you you won't regret ready now this video comes from this question this question was found in my comment section and here's how it goes if a patient is set on a title volume of 500 milliliters and an i to e ratio of 1 to 1.5 what is the flow now I'm going to show you how to calculate this in this video but here's the problem you see I need more information I I don't have enough information as it stands right now to know the answer to this question and so I'm going to show you how um and what I mean by this now this is going to be something that you have likely probably never seen before you've never seen this box I know you've seen the magic box uh this is not the ma magic box this is what I call the wizard box I don't know why I call it the wizard box um the first time I did this with some students and I drew this little triangle up here they said it look like little wizard hat so that's why I call it the wizard box okay and so um but this is how I think about this this is not anything you're going to see in a textbook uh this is just the way my brain works in how I can figure out all of these different elements that are happening during mechanical ventilation when I only have a couple of items now remember we were told that we had a we were told that that we had a title volume of 0.5 L now I know what you're thinking right now no they said it was 500 milliliters the first thing you have to do in respiratory therapy is be able and be comfortable with transitioning from units of measurement so we know that 500 milliliters equals half a liter okay now they also told us that our ID ratio was 1 to 1.5 you see that doesn't really help us much because because I ratio is only valuable when you know the size of the piece that you're cutting up and other words what we do know right here is that the ID ratio is one to one and a half which tells us that for every one part we're spending in Inspiration we're spending one and a half times that in exhalation the problem is is we don't know how many parts we're playing with we do know that again here our title volume is .5 lers and we know that our I to e is 1 to 1.5 but I need some more information okay so here's what I'm going to show you we've got eight things on this list title volume flow I time e time I to e total cycle time respiratory rate and minute volume those are the key components to answering this question now here's what's going to blow your mind if you know three of these then you can figure out all of the other ones All You Need Is three out of eight and you can figure out everything else now there is a caveat to this there's always that one Oddball and the one Oddball here is is the three that you were given cannot be these three right here if you tell me my title volume is 0.5 liters and my flow is 50 lers per minute and my eye time is um whatever that would come out to be I still don't have enough information but if you give me three of any of the other ones I can figure it out and I'm going to prove it to you right now so what we're going to do here is I'm going to say okay I told you I need more information right so what I'm going to do is just say okay I need to know say you give me a respiratory rate so let's just say that the respiratory rate down here is 15 and I say okay now I got something to work with okay I got something to work with now because now I can calculate my total cycle time so I'm doing all this live so you're going to have to deal with the the the um the calculator here if my rate is on 15 and I'm giving 15 breaths a minute then all I simply have to do is say 60 seconds divided by 15 means that my total cycle time is 4 seconds now you see what I just did now I know how big the piece of the p high is that I'm breaking up like this see now all I have to do is go okay 4 seconds divided by 2.5 why I do 2.5 because I need to know how many total Parts I'm playing with one part inspiration one and a half Parts exhalation 2.5 Parts total so all I have to do is this four divided by 2.5 that means that every part is 1.6 okay so four 4 seconds divided in 2 and a half to Total Parts two and a half that means that every single part is 1.6 seconds one part is how much 1.6 seconds that means my eye time is 1.6 seconds now to get my e time all I have to do is do 1.6 times 1.5 so I say okay 1.6 * 1.5 the answer here [Music] 2.4 seconds now if you ever want to check this because you're like that's that's not how that works watch this 1.6 plus 2.4 if you add I time plus e time then you get total cycle time 1.6 + 2.4 equals 4 so it is adding up and it is correct so we know where we are right there okay now once we know that our I time is 1.6 seconds then now we can figure out what our flow is see this was the main thing we had to get to we needed to know what our ey time was so that we know our title volume is is 0.5 lers we needed to know this so that we could calculate this now what we know is that flow equals tital volume divided by I time so now all I have to do is say 0.5 lit and this is why it's important to put that into liters because flow is reported in liters per minute so what we're going to see here is very important 0.5 lers divided 1.6 seconds that means our flow is 3125 lers per second why is it liters per second because we divide it by seconds so to get it in the minutes all we have to do is multiply this times 60 so we say Okay times 60 and guess what that gives us a flow of 18.75 lers per minute now I I know I I know that's not a good flow range okay I'm just showing you the math that's all it is so does it work is that what the flow is if these are are the numbers that we're dealing with that's what the flow is okay and so we don't have to like it but we do have to recognize that that's what it is now here's where this gets crazy right because we can come over here and fill this out our flow is 18.75 our I time 1.6 seconds our e time 2.4 seconds our total cycle Time 4 seconds so what does that leave us leaves us our minute ventilation well guess what we could have just come over here and done this right off the B because what we know is tital volume and respiratory rate together give us minute ventilation so now we just say 15 * .5 equals 7.5 L per minute so this is 7.5 lers you want to see the craziest thing you want to know something else if you multiply your minute ventilation times your total Parts it will give you your low so you see we could have actually just started right here we could have just done this when we knew our rate was 15 we could have went minute ventilation equals 7 and a half and all we have to do is this right here seven remember our total Parts is 2.5 1+ 1.5 is 2.5 right watch this 7 and a half multiply times that 7.5 * 2.5 what do you think it equals 18.75 all this checks out and I love it I think it's so cool now I told you I was going to give you multiple examples I'm going give you two more right now so this time we're going to say okay what if we know that our flow is 60 lers per minute then we say okay our title volume is still 0.5 our flow is 60 lers per minute and we're going to stick with this ID of 1 to 1.5 okay so you say okay Joe F in the blanks show me how we can gather the rest of these from that information and if you want to pause this video and you want to work through it and then come back and check it that's what I would encourage you to do because this is when you understand mechanical ventilation and the components of it okay so here we go um we have title volume and we have our uh flow so we're going to start off by getting our ey time now remember if we need to get ey time we know that I time equals tidal volume divided by flow in l/ second so we do 60 ID 60 that means we're delivering one liter per second so now we just have to do 0.5 divided by 1 and our I time is going to be 0.5 seconds okay now if we know our eye time is 1 is .5 seconds and we know that we're spending 1 and a half half times that in E time then we just have to do 5 * 1.5 and that gives us 7.5 and this is also seconds that's a lie don't don't don't see don't let me do things like that we have to do 0.5 * 1.5 that's going to be that's going to be 75 let me just start this over7 75 seconds so now I say okay that's all great Joe but how we going to get this down here well remember total cycle time is I time plus e time so if we do um 0.5 plus 75 then now we have a total cycle time of 1.25 seconds again not ideal so not a lot of time to get air in and out but that that's what it is if we know that our total cycle time is 1.25 seconds then all we have to do is go 60 seconds divided by 1.25 means we have a respiratory rate of 48 breaths per minute we're clearly dealing with a pediatric here right probably not though with a tit of volume of 500 so again just demonstrating the math right so we see where we have all this stuff filled in right we know that our I time is 0.5 seconds we know that our e time is7 75 seconds we know that our total cycle time is 1.25 we know that our respiratory rate is 48 breaths per minute we can now get our minute volume title volume times respitory rate equals 48 * 05 is going to be 24 and remember the magic how to trick it how how to check it off not trick it how to check it 24 lers per minute times our total Parts which is 2.5 let's just see if this works 24 * 2.5 equal 60 L per minute that's how you do it I got one more for you here we go all right this time we're going to do uh we know a minute ventilation okay so we know that we have a minute ventilation of um I don't know let's just say let's just say um 12 L per minute okay just making this up 12 lers per minute so over here remember minute ventilation goes right here 12 lers per minute and our I to e 1 to 1.5 our title volume is 0.5 okay now we can do this multiple ways th this can literally be done multiple ways right here right because what we see is is we could use these two numbers to get our respitory rate to get our total cycle time and then use our IE to get our I time and our e time or or we could say 12 L per minute times 2.5 is going to give us our flow so let's just do it like that let's just see what happens when we do it like this let's see if it works 12 * 2.5 equal 30 L per minute now we can get our I time because we know title volume and we know flow so now we do title volume remember we got to turn this into liters per second so 30 ID 60 is 0.5 so it's 0.5 / .5 and that gives us a one second I time if we say okay if I have a 1 second I Time 1 time 1.5 we have a 1 and a half second e Time 1 + 1 and a half equals total cycle time 2.5 seconds now let's just see what happens here if we do 60 / 2.5 that means we should have a respiratory rate of 24 60 seconds each breath is 2 and 1 half seconds that means our respirat rate is 24 breaths per minute but also we can double check that if our minute ventilation is 12 then we can do 12 L per minute divided by 0.5 guess what we get 24 we can also say 24 time .5 24 * .5 12 so many different ways to do this when you understand how all of these things play together you are a better more well-rounded respiratory therapist and stuff like this gets fun because you understand all the intricacies of what's happening between flow and I time and E time and total cycle time and and I toe ratio we can now take better care of our patients because we understand that hey that's the wizard box I just named it just now I'm rer coach stay here with me on YouTube at respiratory coach do me a favor hit the Subscribe button comment um um and S hit me a like if you would I really appreciate that Instagram and Tik Tok resty coach LinkedIn at Joe Lewis always send me an email rest per coach gmail.com send me your questions and maybe you'll see it up here in a future video remember at the end of the day every single day average is easy don't be it