Difference between revisions of "Airway pressure release ventilation"

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==Overview==
 
==Overview==
 
*Also known as BiVent, depending on the ventilator manufacturer
 
*Also known as BiVent, depending on the ventilator manufacturer
*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>
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*Uses high constant pressure (P<sub>high</sub>) to recruit alveoli ("open lung" ventilation) with intermittent mandatory releases, 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>
 
*Utilizes:
 
*Utilizes:
 
**Inverse ratio
 
**Inverse ratio
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==Procedure==
 
==Procedure==
*Start PHigh at PPlat at 28, try not to go beyond 35 cmH2O
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*Start P<sub>High</sub> at P<sub>Plat</sub> if on volume control or peak pressure if on pressure control, try not to go beyond 35 cmH2O
*PPlateau = desired Pmean + 3 cmH2O
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*P<sub>Plateau</sub> = desired P<sub>mean</sub> + 3 cmH2O
*PLow at 0 cmH2O for maximal expiration
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*P<sub>Low</sub> at 0 cmH2O for maximal expiration
*THigh at 4.5-6 seconds (inspiratory time)
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*T<sub>High</sub> at 4.5-6 seconds (inspiratory time)
*Tlow at 0.5-0.8 seconds (expiratory time), with TV 4-6 cc/kg
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*T<sub>low</sub> 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>
 
*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>
 
*Wean by "dropping and stretching"
 
*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
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**Every two hours or as tolerated, decrease P<sub>High</sub> by 1-2 cmH2O and increasing T<sub>High</sub> by 0.5 seconds per 1 cmH2O drop in P<sub>High</sub>
 
**Monitor for drop in SpO2, increased work of breathing, tachypnea
 
**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
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**Once P<sub>High</sub> reaches 10 cmH2O and T<sub>High</sub> reaches 12-15 seconds with spontaneous respirations, change mode to CPAP with PEEP 10 cmH2O and PS 5-10 cmH2O, turn ATC off
  
 
==Complications==
 
==Complications==

Latest revision as of 00:02, 23 May 2021

Overview

  • Also known as BiVent, depending on the ventilator manufacturer
  • Uses high constant pressure (Phigh) to recruit alveoli ("open lung" ventilation) with intermittent mandatory releases, if minimal to no respiratory acidosis[1][2]
  • Utilizes:
    • Inverse ratio
    • Pressure controlled
    • Intermittent mandatory ventilation
    • With unrestricted spontaneous breathing

Indications

  • Severe ARDS, rescue therapy
  • Full benefit of APRV is in patients that are not paralyzed that can provide spontaneous breaths

Contraindications

Equipment Needed

Procedure

  • Start PHigh at PPlat if on volume control or peak pressure if on pressure control, 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]
  • Wean by "dropping and stretching"
    • Every two hours or as tolerated, decrease PHigh by 1-2 cmH2O and increasing THigh 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 reaches 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

Mechanical Ventilation Pages

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.