Difference between revisions of "Airway pressure release ventilation"

(Overview)
(Procedure)
 
Line 17: Line 17:
  
 
==Procedure==
 
==Procedure==
*Start P<sub>High</sub> at P<sub>Plat</sub> at 28, try not to go beyond 35 cmH2O
+
*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
 
*P<sub>Plateau</sub> = desired P<sub>mean</sub> + 3 cmH2O
 
*P<sub>Plateau</sub> = desired P<sub>mean</sub> + 3 cmH2O
 
*P<sub>Low</sub> at 0 cmH2O for maximal expiration
 
*P<sub>Low</sub> at 0 cmH2O for maximal expiration

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.