APRV, BiLevel, BiVent
4.5 (2 ratings)
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APRV, BiLevel, BiVent

Utilizing Airway Pressure Release Ventilation
4.5 (2 ratings)
Instead of using a simple lifetime average, Udemy calculates a course's star rating by considering a number of different factors such as the number of ratings, the age of ratings, and the likelihood of fraudulent ratings.
30 students enrolled
Created by K. Scott Richey
Last updated 12/2015
English
Price: $20
30-Day Money-Back Guarantee
Includes:
  • 2 hours on-demand video
  • 13 Articles
  • Full lifetime access
  • Access on mobile and TV
  • Certificate of Completion
What Will I Learn?
  • Participant will become familiar with terminology specific to Airway Pressure Release Ventilation
  • Participant will become familiar with Mode set-points
  • Participant will be introduced to indications & contra-indications
  • Participant will become familiar with initial setup of airway pressure release ventilation
  • participant will be introduced to optimizing settings for increasing oxygen, decreasing paCo2, & weaning.
View Curriculum
Requirements
  • Video play back capabilities
Description

The purpose of this Air Ventilation System: APRV, Bilevel, Bivent course is to provide the clinician with a handy, easy-to-use reference containing primary information in regards to utilizing APRV as a ventilator modality.

The reference includes:</p>

  • Overview of APRV
  • Description of settings
  • Indications
  • Relative contra-indications
  • Procedure (Adult, Pediatric, & Neonatal settings)
  • Initial setup
  • Transitioning from conventional mechanical ventilation
  • Transitioning from High-frequency mechanical ventilation
  • optimization of settings
  • increasing O2
  • decreasing CO2
  • Weaning

Take this ultimate Air Ventilation System course right now and learn how to use APRV, Bilevel, Bivent.

Who is the target audience?
  • Respiratory Therapist, RT Students, Physicians, Nurses
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Curriculum For This Course
37 Lectures
01:50:37
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Introduction
3 Lectures 08:52
This is a brief overview of airway pressure release ventilation.
Synopsis of Airway Pressure Release Ventilation
00:22

Many ventilator manufacturers have airway pressure release ventilation as a mode on their ventilators. However, due to copyright laws each have their own name for the mode. 
Preview 04:19

If one wants to actually classify APRV this video overviews classification. 
Preview 04:11
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Mode Settings
5 Lectures 21:00

APRV only has four primary operator set-points, these include P-High, PLow, T-High, & T-Low.

 Secondary settings are the Fio2, trigger, pressurization rate, expiratory termination, & Pressure support. 


Overview of Settings
07:43

The P-High setting controls the upper pressure or upper CPAP level. The P-High phase regulates end inspiratory lung volume & is analogues with mean airway pressure.

P-High
03:08

This video describes the P-Low setting.
P-Low
02:46

The T-High Setting controls the time for the upper CPAP level or P-High  phase. The T-High provides sustained recruitment, allowing for improved gas exchange by increasing alveolar surface area & exposure time.

T-High
02:59

The T-Low setting establishes the time interval for the low CPAP phase. This time allows for a intermittent release in airway pressure, which augments PaCO2 removal and off loads the respiratory muscles of the work related to pure CPAP breathing.

Note- T-Low should not be considered as expiratory time, since the patient may exhale throughout the entire P-High phase.

T-Low
04:24
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Indications and Contra-indications
2 Lectures 07:54

Indications

• PaO2/ FiO2 Ratio < 300.

• Bilateral infiltrates (consistent w. edema, patchy, diffuse).

• No evidence of left atrial hypertension.

Indications
03:09

Relative Contra-indications

• Serve COPD, emphysema

• Pneumothorax

• Blood pressure: < 90 systolic or < 60 mean

• Unilateral lung disease

Contra-Indications
04:45
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Initial Setup: P-High
4 Lectures 11:28
This lecture provides an overview when initially setting P-High.
Preview 00:12

Set P-High 2 cmH20 above the measured plateau pressure, from the conventional settings.

Selecting a P-High When Transitioning from Traditional Mechanical Ventilation
04:04

This lecture provides an overview when transitioning from HFOV.
Selecting a P-High when Transitioning from HFV
02:03

This lecture provides an overview when initially setting P-High, based on P/V curve results. 
Selecting a P-High Based on the Pressure/Volume Curve
05:09
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Inital Setup: T-High
1 Lecture 00:03
This lecture provides an overview when initially setting T-High.
T-High Initial Setting
00:03
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Initial Setup: P-Low
1 Lecture 00:08
This lecture provides an overview when initially setting P-Low. 
P-Low Initial Setting
00:08
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Initial Setup: T-Low
4 Lectures 20:52
This lecture provides an overview when initially setting T-Low. 
T-Low Initial Settings
00:05

T-Low: Based on the “Expiratory Time Constant Measurement”

Setting T-Low based on the expiratory time constant measurement is simple & precise. Set T-low at the same interval as the measured RCexp value. 

Rationale- using this measurement sets the T-Low to maintain lung volume at ~ 75% of the Peak Expiratory Flow Rate. This ensures expiratory lung volume & prevents alveolar closure during the release phase

Setting T-Low Based on the Expiratory Time Constant
03:59

T-Low: Setting Based on the Expiratory Flow Waveform

Titrate T-Low to obtain a “Peak Expiratory Flow Termination Point” (T-PEFR) at 50-75% of the measured “Peak Expiratory Flow Rate” (PEFR).

Rationale- lung mechanics may change which changes the expiratory time constant, T-Low should be reassessed for optimal setting.

Setting T-Low Based on the Expiratory Flow Waveform
09:13

This lecture provides an overview when initially setting T-Low to achieve lung protective goals. 
Setting T-Low to achieve lung protective goals
07:35
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Initial Settings: Secondary Settings
2 Lectures 00:22
This lecture provides an overview when initially setting the trigger. 
Trigger
00:13

This lecture provides an overview when initially setting FiO2. 
FiO2
00:09
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Optimizing Settings: Improving Oxygenation
5 Lectures 17:59
This lecture provides an overview to improve oxygenation by titrating the T-Low setting. 
Titrating T-Low
02:40

This lecture provides an overview to improve oxygenation by increasing P-High.
Increasing P-High
01:57

This lecture provides an overview to improve oxygenation by increasing T-High & P-High.
Increasing T-High & P-High
02:28

This lecture provides an overview to improve oxygenation by evaluating the esophageal pressure. 
Titrating P-High Based on Esophageal Manometry
05:17

This lecture provides an overview to improve oxygenation by evaluating Volumetric CO2. 
Titrating P-High Based on Volumetric Carbon Dioxide
05:37
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Optimizing Settings: Decreasing PaCO2
4 Lectures 07:18
This lecture provides an overview in decreasing PaCO2 by evaluating sedation. 
Sedation & Spontaneous Frequency
00:12

This lecture provides an overview in decreasing PaCO2 by assessing expiratory flow. 
Assessing Expiratory Flow
02:52

This lecture provides an overview in decreasing PaCO2 by increasing minute ventilation. 
Increasing Minute Ventialtion
04:11

This lecture provides an overview in decreasing PaCO2 by evaluating pH goals.
pH Goals
00:03
3 More Sections
About the Instructor
K. Scott Richey
4.5 Average rating
2 Reviews
30 Students
1 Course
Author, Content developer, Registered Respiratory Therapist

My academic Background consists of healthcare, pre-hospital education, fire suppression, and mechanical instrument calibration and repair. I have over twenty years of combined pre-hospital emergency medicine and healthcare experience. Twelve of the years have been in Respiratory Therapy working with all patient populations.

Over the years I have provided training for greater than 2000 healthcare workers in Basic Life Support, Advance Life Support, Pediatric Advance Life Support and applications and concepts of mechanical

ventilation in anesthesia and the intensive care unit. These groups have been comprised of patients, community members, EMT's, paramedics, medical students, physicians, CRNA's, Nurse Practitioners, RN's, Respiratory Therapist, anesthesia technicians, and Biomedical technicians.

Additionally, I have provided numerous presentations and authored various training materials for both clients and my own staff members.