Difference between revisions of "Airway pressure release ventilation"

(Overview)
(Procedure)
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==Procedure==
 
==Procedure==
 
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*[[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
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**Wean by "dropping and stretching"
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***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

References

  1. CritCareMed. 2005;33:S228 Other Approaches to Open-Lung Ventilation–Airway Pressure Release Ventilation.
  2. CleveClinJMed 2011;78:101 Airway Pressure Release Ventilation–Alternative Mode of Mechanical Ventilation in Acute Respiratory Distress Syndrome.
  3. Guttmann J et al. Automatic tube compensation (ATC). Minerva Anestesiol. 2002 May;68(5):369-77.