Airway Pressure Release Ventilation APRV

Описание: For the majority of patients admitted to ICU with hypoxic respiratory failure, a conventional ventilatory strategy using volume, pressure or dual control modes with PEEP is usually very effective. With severe lung injury it may be necessary to administer neuromuscular blockade, turn the patient prone and increase the mean airway pressure using PEEP or inverse ratio ventilation (IRV). If these interventions are unavailable, ineffective or inadequate, rescue therapies may be required. One easily available rescue therapy is Airway Pressure Release Ventilation (APRV).
APRV is an extreme version of IRV that looks analogous to using CPAP at high airway pressure levels (e.g. 28cmH2O). Intermittently that high airway pressure is released to remove CO¬ – the release time (less than 1 second) being too short to cause lung derecruitment.
Using modern ventilators it is possible utilize the inspiratory capacity to oxygenate the patient (flipping the respiratory cycle from expiration as the primary time of gas exchange to inspiration) and allow the patient to breath spontaneously. The spontaneous efforts have been shown to improve both gas exchange and cardiovascular performance – but they are not necessary when using this ventilator strategy. Gasping should be avoided.
This tutorial covers the science behind APRV, how to set it up, how to use it as part of a ventilator strategy in ARDS, the strengths and limitations of this approach and how to wean it. I guarantee you will learn something.
@ccmtutorials www.ccmtutorials.org

Contents
00:09 Introduction
00:46 Review of Previous Tutorial
02:00 Clinical Scenario – Harry Motorcycle Courier, Major Trauma, Massive Resuscitation
03:10 Review of Lung Volumes (and lung volumes looked at a different way)
05:18 Impact of Lung Injury on Lung Volumes, In Particular FRC
07:22 How Inverse Ratio Ventilation Utilizes Inspiratory Capacity
08:22 Strategy From Managing Acute Hypoxic Respiratory Failure (when conventional therapy fails)
11:00 Airway Pressure Release Ventilation – What It Is
14:30 APRV with Spontaneous Breaths
15:20 Proven Advantages of APRV with Spontaneous
16:20 Patient Selection
18:00 APRV Settings (all ventilators)
20:20 Setting The Respiratory Rate and Inspiratory Time
23:05 Ventilator Settings – Puritan Bennett 980
26:40 Ventilator Settings – Drager Evita Infinity
28:30 Getting to Grips with Hypercarbia
30:30 Weaning from APRV
32:18 Limitations to Using APRV
33:16 Review of Tutorial