The Peak Inspiration Podcast

Nicholas Ghionni (@pulmtoilet)
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  • Medicine
  • Twice monthly

I'm Nicholas Ghionni, a pulmonary and critical care physician with a passion for making mechanical ventilation easier to understand. Whether you're an EMT, nurse, respiratory therapist, APP, resident, fellow, attending, or simply someone who loves critical care physiology, this podcast is for you. My goal is simple: break down complex ventilator concepts into practical, understandable lessons you can apply at the bedside. For more complex waveform breakdowns and simple explanations of complex mechanical ventilation physiology: follow me on Instagram at @pulmotoilet

  1. 6 Aug

    Mechanical Ventilation in the CVICU with Myocardial Mastery!

    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.

  2. 24 Jun

    Dyssynchrony Bootcamp day 1 sample!

    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!

  3. 10 Jun

    PRVC sucks!

    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! pulmcritnick@gmail.com

  4. 3 Jun

    Ventilating Severe Acidosis: ResusX edition!

    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!!

  5. 28 May

    What is SIMV?

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

  6. 22 Apr

    Autopeep discussion from Instagram waveform!

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

  7. 21 Apr

    Pressure Control 2 Webinar Sample : Abnormal Waveforms!

    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.

  8. 16 Apr

    Autotrigger & the Airway Occlusion Pressure

    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.

See All (25)

About

I'm Nicholas Ghionni, a pulmonary and critical care physician with a passion for making mechanical ventilation easier to understand. Whether you're an EMT, nurse, respiratory therapist, APP, resident, fellow, attending, or simply someone who loves critical care physiology, this podcast is for you. My goal is simple: break down complex ventilator concepts into practical, understandable lessons you can apply at the bedside. For more complex waveform breakdowns and simple explanations of complex mechanical ventilation physiology: follow me on Instagram at @pulmotoilet

Information

  • Creator
    Nicholas Ghionni (@pulmtoilet)
  • Years Active
    2025 - 2026
  • Episodes
    25
  • Rating
    Clean
  • Copyright
    © Nicholas Ghionni (@pulmtoilet)
  • Show Website
    The Peak Inspiration Podcast

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