Airway pressure release ventilation
Overview
- Also known as BiVent, depending on the ventilator manufacturer
- To recruit alveoli, 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
Equipment Needed
Procedure
- Start PHigh at PPlat at 28, 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
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous
External Links
- https://litfl.com/airway-pressure-release-ventilation/
- https://ccforum.biomedcentral.com/articles/10.1186/cc9419
- https://emcrit.org/squirt/aprv/
References
- ↑ CritCareMed. 2005;33:S228 Other Approaches to Open-Lung Ventilation–Airway Pressure Release Ventilation.
- ↑ CleveClinJMed 2011;78:101 Airway Pressure Release Ventilation–Alternative Mode of Mechanical Ventilation in Acute Respiratory Distress Syndrome.
- ↑ Guttmann J et al. Automatic tube compensation (ATC). Minerva Anestesiol. 2002 May;68(5):369-77.