Airway pressure release ventilation: Difference between revisions
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==Overview== | ==Overview== | ||
*Also known as BiVent, depending on the ventilator manufacturer | *Also known as BiVent, depending on the ventilator manufacturer | ||
* | *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 | ||
| Line 13: | Line 13: | ||
==Contraindications== | ==Contraindications== | ||
*Main limitation is respiratory acidosis given minimal ventilation | |||
==Equipment Needed== | ==Equipment Needed== | ||
==Procedure== | ==Procedure== | ||
*Start | *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>Low</sub> at 0 cmH2O for maximal expiration | ||
* | *T<sub>High</sub> at 4.5-6 seconds (inspiratory time) | ||
* | *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 | **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 | **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== | ||
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==External Links== | ==External Links== | ||
*https://litfl.com/airway-pressure-release-ventilation/ | *[https://criticalcarenow.com/aprv-101-peep-to-the-max/ CriticalCareNow: APRV PEEP to the Max] | ||
*[https://litfl.com/airway-pressure-release-ventilation/ Life in the Fast Lane: Airway Pressure Release Ventilation] | |||
*[https://emcrit.org/squirt/aprv/ PulmCrit: APRV] | |||
*https://ccforum.biomedcentral.com/articles/10.1186/cc9419 | *https://ccforum.biomedcentral.com/articles/10.1186/cc9419 | ||
==References== | ==References== | ||
Latest revision as of 09:28, 3 January 2022
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
- Main limitation is respiratory acidosis given minimal ventilation
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
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous
External Links
- CriticalCareNow: APRV PEEP to the Max
- Life in the Fast Lane: Airway Pressure Release Ventilation
- PulmCrit: APRV
- https://ccforum.biomedcentral.com/articles/10.1186/cc9419
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.