Airway pressure release ventilation: Difference between revisions

 
(One intermediate revision by the same user not shown)
Line 36: Line 36:


==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
*https://emcrit.org/squirt/aprv/


==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

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.