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Airway Pressure Release Ventilation - Pulmonary Medicine - Lecture Slides, Slides of Pneumology

Airway Pressure Release Ventilation, Ventilator Cycles, Levels of CPAP, Upper Pressure Level, Baseline Airway Pressure, Eliminating Waste Gas, Mandatory Breaths, Spontaneous Breathing. Its Pulmonary Medicine lecture. Some slides title are given above to give hints of topic of this lecture. This alone lecture can not teach you all about Pulmonology but full series of lectures in my files can. Enjoy my friends.

Typology: Slides

2011/2012

Uploaded on 12/22/2012

anna.joe
anna.joe 🇮🇳

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APRV
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Airway PressureRelease Ventilation

APRV

APRV zVentilator cycles between two differentlevels of CPAP – an upper pressure leveland a lower level zThe two levels are required to allow gasmove in and out of the lung zBaseline airway pressure is the upperCPAP level, and the pressure isintermittently “released” to a lower level,thus eliminating waste gas

APRV SET UP

APRV Settings zExpiratory time variable:

↓^ enough to prevent derecruitment &

↑enough to obtain a suitable TV (0.4 to 0.6 s) – Target TV (4-6ml/kg) zIf the TV is inadequate

→^ expiratory time is lengthened zIf TV too high (>6ml/kg)

→^ expiratory time is shortened

APRV Settings zThe inspiratory time is set at 4-6 seconds(the respiratory rate should be 8 to 12breaths per minute - never more) zI:E ratio: at least 8:1 and zTime at low pressure level should be brief(0.8 sec)

APRV Settings zNeuromuscular blockade should beavoided: the patient allowed to breathspontaneously (beneficial) zThe breaths can be supported withpressure support - but the plateaupressure should not exceed 30cmH2O

APRV Benefits zPreservation of spontaneous breathingand comfort with most spontaneousbreathing occurring at high CPAP z↓WOB z↓Barotrauma z↓Circulatory compromise zBetter V/Q matching

APRV Evidence zAPRV vs pressure controlled conventionalventilation patients with ALI after trauma (

n

= 30) zRandomized controlled, prospective trial z↓ICU days, ventilator days, better gasexchange, hemodynamic, lung comp, z↓Need for sedation and vasopressors

Varpula et al. Acta Anasthesiol Scand 2003

APRV Evidence zStock (1987) APRV vs. IPPV; dogs withALI (n = 10):

Better zRasanen (1988)

APRV vs. conventional ventilation vs. CPAP; anesthetized dogs (n= 10): Similar zMartin (1991)

APRV vs. CPAP vs. conventional ventilation :

Better zDavis (1993) APRV vs. SIMV; surgerypatients with ALI (n = 15) Similar

APRV zRathgeber (1997): APRV vs conventionalventilation vs. SIMV; patients after cardiacsurgery

(n = 596) zShorter duration of intubation: (10 hrs)than SIMV (15 hrs) or conventionalventilation (13 hrs) z↓Sedation&analgesia requirement zProspective, randomized, controlled, opentrial over 18 months, unevenrandomization

Mandatory Minute Ventilation zClosed loop ventilation: ventilator changesit’s output based on measured based on ameasured input variable zSpontaneous breaths: pressure control isused zIf anticipated V

< set (based on MV ofE^ past 30 sec): Mandatory breaths which areVC, time triggered

MMV zIn contrast to SIMV: MMV givesmandatory breaths only if spontaneousbreathing has fallen below a pre-selectedminimum ventilation