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High-frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a practical guide. October 11, 2010

Posted by admin in : Strategies, Ventilation , comments closed

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Abstract

Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syndrome (ARDS) will die, some from progressive respiratory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory ventilation and airway pressure release ventilation. Both modalities are based on the principles of the open-lung concept and aim to improve oxygenation by keeping the lung uniformly inflated for an extended period of time. Although a mortality benefit has not been proven, some patients may benefit from these alternative modes of ventilation as rescue measures while the underlying process resolves. The purpose of this article is to review the evidence and mechanisms underlying each modality and to describe the fundamental steps in initiating, adjusting, and terminating these modes of ventilation.

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APRV PowerPoint September 29, 2010

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David Pitts II, RRT

BY:

Clinical Applications Specialist, Maquet

Birmingham, Alabama

Sponsored by Maquet, Inc – Servo Ventilators

APRV (3.5 Mb)

APRV, PRVC, PAV September 19, 2010

Posted by admin in : APRV, Featured Articles, Multimedia Library, Strategies, Ventilation , comments closed

Current modes of ventilation explained:

APRV/PAV/PRVC/etc…

Excerpt:

    • Recruitable low compliance lung disorders
    • Lung dysfunction secondary to thoracic restriction i.e.. obesity, acites
    • Inadequate oxygenation with FiO2 > .60
    • PIP> 35 cmH2O and /or PEEP>10 cmH2O
    • Lung protective strategies (high PEEP, low Vt) are failing
  • Can be used with other interventions i.e.. INO therapy, prone positioning

  • APRV

    Airway Pressure Release Ventilation (Power Point)

    Ventilation Modes

    APRV Clinical Guide (From Respiratory Resource)

    “Long-term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume-controlled inverse ratio ventilation” October 12, 2010

    Posted by admin in : APRV, HFOV, Ventilation , comments closed

    Thank you to:
    Babak Sarani, MD
    Assistant Professor of Surgery
    Co-Director of the Rapid Response Team
    Division of Traumatology and Surgical Critical Care
    University of Pennsylvania

    Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syn- drome (ARDS) will die, some from progressive respira- tory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory venti- lation and airway pressure release ventilation. Both modalities are based on the principles of the open-lung concept and aim to improve oxygenation by keeping the lung uniformly inflated for an extended period of time.

    Copyright all rights reserved. Provided to BCRT.ca for educational purposes ONLY.

    HFO_APRV published

    "Long-term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume-controlled inverse ratio ventilation" October 12, 2010

    Posted by PeterD in : HFOV, Ventilation , comments closed

    Thank you to:
    Babak Sarani, MD
    Assistant Professor of Surgery
    Co-Director of the Rapid Response Team
    Division of Traumatology and Surgical Critical Care
    University of Pennsylvania

    Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syn- drome (ARDS) will die, some from progressive respira- tory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory venti- lation and airway pressure release ventilation. Both modalities are based on the principles of the open-lung concept and aim to improve oxygenation by keeping the lung uniformly inflated for an extended period of time.

    Copyright all rights reserved. Provided to BCRT.ca for educational purposes ONLY.

    HFO_APRV published

    Long-term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume-controlled inverse ratio ventilation October 11, 2010

    Posted by admin in : Ventilation , comments closed

    The improvement was significantly different between both ventilatory modes (p < 0.01). We conclude that this indicates a progressive alveolar recruitment over time during ventilation with APRV.

    Link

    Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrom September 29, 2010

    Posted by admin in : APRV, Ventilation , comments closed

    Conclusion

    APRV may be used safely in patients with ALI/ARDS, and decreases the need for paralysis and sedation as compared with PCV-inverse ratio ventilation (IRV). APRV increases cardiac performance, with decreased pressor use and decreased airway pressure, in patients with ALI/ARDS

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