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>
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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.
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.
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.
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.
• PaO2/ FiO2 Ratio < 300.
• Bilateral infiltrates (consistent w. edema, patchy, diffuse).
• No evidence of left atrial hypertension.
• Serve COPD, emphysema
• Blood pressure: < 90 systolic or < 60 mean
• Unilateral lung disease
Set P-High 2 cmH20 above the measured plateau pressure, from the conventional settings.
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
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.
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.