He had an acute lung edema when he came through the door of our ICU accompanied by emergency team and an Oxylog aside because of the probability of respiratory arrest.

Extreme sweating, that typical pallor, wheezing to listening with the stethoscope, stridor to simple ear… He breathed with thoraco-abdominal asynchrony, saturation was 86%, high flow with reservoir O2 mask when he was admitted at ICU.

The comment from the Emergency physcian of 061 was very hard: “An ALE in respiratory pre-respiratory arrest, we have not waited to chest RX, he is receiving nitro, and we have already started with norphic chloride and diuretics”.

I had read in several articles after I replied in my courses and conferences, that the most important variable of the success of the non-invasive ventilation was the skill of the nurse within two hours at the start of the technique. At that moment I decided that everything was going to change… How?.


I convinced the doctor of adjust values of PEEP and pressure support (PS) according to the instructions the patient gave according what he felt. The doctor gave me 5 minutes but not before asking the assistant to be prepare for the intubation.

I considered that man who I did not know someone able, taking his own decisions, perhaps suffering a strong sensation of near death and I said: “You will note several things even some unpleasant, but in short time if you help us, you will notice the improvement – I told him while preparing the mask to his face-.”

First a certain force will prevent you to empty your lungs – all is the PEEP, I said to myself. You must keep on, and soon you will begin to notice the benefits that will go to more – he will be recruiting,  I thought.

Then a blast of air that you don’t control will serve air in all the breaths – the PS, I said my inside-. According you, I can serve more or less. Perhaps at the beginning we do not program it well and that is: that you help us to know if we are doing well. We will be adjusting both depending on what you tell us.” 

 
 
That look of fear became pure collaboration. The values of PEEP and PS were adjusting very quickly. Gestures and looks to say “right or wrong”, “more or less”, “thumbs raised or not”… And after 15 minutes it was obvious that he was not going to be intubated.

For a lover of technology, with this experience I would like to share the idea that technology is human, or that people make it human.

How? With our knowledge, skills, and the management of emotions.
 

Modality Manager Intensive Care Area at Dräger Hispania & Portugal
Associated Teacher at UdG – Universitat de Girona