Transcript APRV - Respiratory Therapy Files

APRV
By Kellianne McCaffrey and Rowena
Eason
What is it?
Airway Release Pressure Ventilation is a
method of ventilation that provides two
levels of continuous positive airway
pressure (CPAP) and allows spontaneous
breathing at both levels.
It is time triggered and time cycled
Ideally, promote higher MAP and
improve oxygenation
Auto-PEEP and
APRV
Release time does not allow the patient to
expire entirely, intentionally causing an
intrinsic PEEP air trapping to keep alveoli
open
When is APRV
used?
APRV is beneficial to patients with acute
lung injury (ALI) and acute respiratory
distress syndrome (ARDS)
This is because these patients are
difficult to oxygenate based on their
inadequacy of gas exchange
How does it help?
APRV provides consistent lung
recruitment, prolonged and improved
oxygenation through the increased mean
airway pressure
It does NOT increase PIP.
Set up
What is set?
Time-hi (inspiratory)
Time-lo is the time that Low pressure is held
(AW pressure release time to allow for CO2
release ie. expiratory)
Pressure-hi
Pressure-lo
FiO2
What does that
mean?!?
Pressure-Hi is the high pressure given on
inspiration
Pressure-Lo is the Low pressure given on
expiration
Time-Hi is the amount of time the High
pressure is held
Time-Lo is the time that the Low pressure is
held
Basic Parameters
Low Pressure 0 cmH2O, High Pressure 2030 cm H2O
Low Time 0.4-0.6 seconds, High Time 4-6
seconds
adjust accordingly to maintain Vt
between 4-6 ml/kg
Oxygenation status
Different measures will be taken
depending on whether or not the patient
is oxygenating and ventilating well.
T-hi must be increased if patient
remains severely hypoxemic after
beginning APRV
If oxygenation is adequate, the patient
may be ready to be weaned
Weaning
Can be weaned to pressure support.
FiO2 is always weaned FIRST.
Inspiratory time is increased
Pres-lo is increased gradually to 8-10
cmH2O
Pres-hi is decreased, typically 2-3
cmH2O at a time
Weaning (cont’d)
Inspiratory time is increased while the high
pressure is decreased in order to reduce
the total number of release phases.
Ultimately the two pressures are set to
match the MAP and allow the patient to
breathe spontaneously on CPAP
Other names
Each ventilator has a different name for the
same thing
Servo calls it BiVent
Puritan Bennet calls it BiLevel
Drager and Hamilton both call it APRV
APRV rocks!
Rowena’s favorite part about APRV is that it
continuously recruits the lungs and really
helps the ARDS patients.
Kellianne’s favorite part about APRV is the
simplicity of the weaning process.
References
http://www.americannursetoday.com/airway-pressure-release-ventilation-a-boost-for-spontaneous-breathing/http://www.ncbi.nlm.nih.gov/pubmed/24093118
http://www.ccjm.org/content/78/2/101.long#abstract-2
www.respiratorytherapyfiles.net
Pilbeam’s Mechanical Ventilation 5th edition 2012
http://www.ncbi.nlm.nih.gov/pubmed/24093118
http://www.ccmtutorials.com/rs/mv/strategy/page14.htm