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The “How To” of BiVent (APRV)  Created by: David Pitts II, RRT Clinical Applications Specialist, Maquet Birmingham, Alabama Sponsored by Maquet, Inc – Servo Ventilators
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lung Protective Strategies ,[object Object],[object Object],[object Object],[object Object]
Keeping Plateau Pressure < 30 cm H 2 0 ,[object Object]
Alternative Techniques ,[object Object],[object Object],[object Object],[object Object],[object Object]
Indications ,[object Object],[object Object]
Goal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
APRV Description ,[object Object],[object Object],[object Object],[object Object]
Ventilation With APRV ,[object Object],[object Object]
APRV
AKA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Consider APRV when the Patient Has -- ,[object Object],[object Object],[object Object],[object Object],[object Object]
Possible Contraindications ,[object Object],[object Object],[object Object],[object Object]
Terminology ,[object Object],[object Object],[object Object],[object Object]
Terminology ,[object Object],[object Object],[object Object]
Bi-Vent Set-up Screen
Advantages of APRV ,[object Object],[object Object],[object Object]
Compared to PCIRV – Advantages of APRV ,[object Object],[object Object],[object Object]
Additional Advantages - Compared to PCIRV ,[object Object],[object Object],[object Object]
New Water Coolers are Being Installed in the ICU Waiting Rooms
Advantages of Spontaneous Breathing ,[object Object],[object Object],[object Object]
Preserve Spontaneous Breathing ,[object Object],[object Object]
Spontaneous v.s. Paralyzed ,[object Object]
Spontaneous v.s. Paralyzed ,[object Object]
Try as we might.  We can’t get away from it?
Other Advantages of Spontaneous Breathing ,[object Object]
Another Advantage ,[object Object],[object Object]
Initial Settings – P High ,[object Object],[object Object],[object Object]
Setting P high ,[object Object],[object Object]
Setting T high ,[object Object],[object Object],[object Object],[object Object]
Setting T high ,[object Object],[object Object],[object Object]
APRV
Release Time - T PEEP ,[object Object],[object Object],FLOW
Setting PEEP or P low  in APRV ,[object Object],[object Object],[object Object]
Establishing T PEEP  (Time at low pressure) ,[object Object],[object Object],[object Object]
Expiratory Flow
T PEEP – Setting The Time ,[object Object],[object Object],[object Object]
T PEEP – Using the Tc
Release Time in ARDS ,[object Object],[object Object]
Rat Lung Model –  Dr. Slutsky
Initial Settings ,[object Object],T High/T low - 12-16 releases T low =  0.5 sec  and  P low = 0 P/F  MAP <250  15-20 <200  20-25 <150  25-28 T High (s)  T low (s)  Freq. 3.0  0.5 17 4.0  0.5 13 5.0  0.5 11 6.0  0.5  9 T high range 4-6 sec. PS- as indicated with special attention given to PIP.
Bi-Vent Settings Set Releases and I:E Create releases and I:E
Bi-Vent Ventilation P High T High T PEEP
Spontaneous Breathing Spontaneous Breaths Patient Trigger (On P High) (On P High)
Spontaneous Breathing w/PS Spontaneous Breaths w/PS
Identifying Lung Recruitment – CO 2  Monitoring
Making Changes in APRV Settings Based on ABGs
Control Settings for CO 2   ,[object Object],[object Object],[object Object]
CO 2  Elimination To Decrease PaCO 2 : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
To Increase PaCO 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of PaO 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Going Too Fast
Weaning From APRV ,[object Object],[object Object],[object Object]
Weaning From APRV ,[object Object],[object Object]
During Weaning ,[object Object],[object Object],[object Object]
Pressure Support with APRV
Weaning Bi-Vent Lower Rate Longer T High Lower P High Add PS
Weaning Bi-Vent Lower Rate Longer T High Lower P High Add PS
 
 
Perceived Disadvantages of APRV ,[object Object],[object Object],[object Object]
Disadvantages of APRV ,[object Object],[object Object],[object Object],[object Object],[object Object]
The End  Thank You!

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APRV

Notas del editor

  1. Maintaining spontaneous ventilation tends to improve ventilation-perfusion matching by preferentially providing ventilation to dependent lung regions that receive the best blood flow.