Airway pressure release ventilation: Difference between revisions
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==Procedure== | ==Procedure== | ||
*[[APRV]] ([[BiVent]]) to recruit alveoli, if minimal to no respiratory acidosis<ref>CritCareMed. 2005;33:S228 Other Approaches to Open-Lung Ventilation–Airway Pressure Release Ventilation.</ref><ref>CleveClinJMed 2011;78:101 Airway Pressure Release Ventilation–Alternative Mode of Mechanical Ventilation in Acute Respiratory Distress Syndrome.</ref> | |||
**Start PHigh at PPlat at 28, try not to go beyond 35 cmH2O | |||
**PPlateau = desired Pmean + 3 cmH2O | |||
**PLow at 0 cmH2O for maximal expiration | |||
**THigh at 4.5-6 seconds (inspiratory time) | |||
**Tlow at 0.5-0.8 seconds (expiratory time), with TV 4-6 cc/kg | |||
**[[Automatic tube compensation]] ON if patient spontaneously breathing<ref>Guttmann J et al. Automatic tube compensation (ATC). Minerva Anestesiol. 2002 May;68(5):369-77.</ref> | |||
**Full benefit of APRV is in patients that are not paralyzed that can provide spontaneous breaths | |||
**Wean by "dropping and stretching" | |||
***Every two hours or as tolerated, decrease PHigh by 1-2 cmH2O and increasing THight by 0.5 seconds per 1 cmH2O drop in PHigh | |||
***Monitor for drop in SpO2, increased work of breathing, tachypnea | |||
***Once PHigh reaches 10 cmH2O and THigh resaches 12-15 seconds with spontaneous respirations, change mode to CPAP with PEEP 10 cmH2O and PS 5-10 cmH2O, turn ATC off | |||
==Complications== | ==Complications== | ||
Revision as of 22:23, 23 March 2020
Overview
- Also known as BiVent, depending on the ventilator manufacturer
- Utilizes:
- Inverse ratio
- Pressure controlled
- Intermittent mandatory ventilation
- With unrestricted spontaneous breathing
Indications
- Severe ARDS, rescue therapy
Contraindications
Equipment Needed
Procedure
- APRV (BiVent) to recruit alveoli, if minimal to no respiratory acidosis[1][2]
- Start PHigh at PPlat at 28, try not to go beyond 35 cmH2O
- PPlateau = desired Pmean + 3 cmH2O
- PLow at 0 cmH2O for maximal expiration
- THigh at 4.5-6 seconds (inspiratory time)
- Tlow at 0.5-0.8 seconds (expiratory time), with TV 4-6 cc/kg
- Automatic tube compensation ON if patient spontaneously breathing[3]
- Full benefit of APRV is in patients that are not paralyzed that can provide spontaneous breaths
- Wean by "dropping and stretching"
- Every two hours or as tolerated, decrease PHigh by 1-2 cmH2O and increasing THight by 0.5 seconds per 1 cmH2O drop in PHigh
- Monitor for drop in SpO2, increased work of breathing, tachypnea
- Once PHigh reaches 10 cmH2O and THigh resaches 12-15 seconds with spontaneous respirations, change mode to CPAP with PEEP 10 cmH2O and PS 5-10 cmH2O, turn ATC off
Complications
See Also
External Links
- https://litfl.com/airway-pressure-release-ventilation/
- https://ccforum.biomedcentral.com/articles/10.1186/cc9419
- https://emcrit.org/squirt/aprv/
References
- ↑ CritCareMed. 2005;33:S228 Other Approaches to Open-Lung Ventilation–Airway Pressure Release Ventilation.
- ↑ CleveClinJMed 2011;78:101 Airway Pressure Release Ventilation–Alternative Mode of Mechanical Ventilation in Acute Respiratory Distress Syndrome.
- ↑ Guttmann J et al. Automatic tube compensation (ATC). Minerva Anestesiol. 2002 May;68(5):369-77.